The Cultural Hegemony of “Mental Health”

Screenshot_2016-09-21-13-41-43In this guest article Dr Bruce Scott challenges the way the “mental health” system and its institutions have been co-opted and actively promote capitalism. This system, driven by a profit motive, rather than a desire to benefit patients, has produced “fear and submission to an ideology which controls and mystifies the masses”. The Department of Work and Pensions is now adopting psychocoercive techniques to get unemployed people back to work, aiming to make us accept the notion that unemployment is a fault deriving from individual attitudes rather than a condition rooted in our current political and economic conditions.

In agreeing with Dr. Scott’s analysis, we urge disabled people, care workers, NHS workers, psychologists and jobcentre staff to contest this system of oppression. Dr. Scott denounces the way cognitive behavioural therapy has been adopted to pressurise people into employment, on the back of neoliberal ideas of normality, positivity, and well-being.

But if these conditions create our misery, and if we are told that our individual attitudes are not good according to the ideology of the neoliberal capitalist system which the DWP and the state are frantically trying to prop up, then resisting the imposition of state-sanctioned psychotherapies and behaviours also means reclaiming those bodies and minds, attitudes and ways of being that the DWP would like to fix as faulty and harmful – for capitalism.

Seeing such resistance and reclamation as a form of sabotage through which we can make the normality of capitalism unworkable in our everyday life, in jobcentres and assessment centres, in medical settings and the workplace, is inevitably also a call for collective action and solidarity in all these contexts.

By Dr Bruce Scott, Psychologist, Psychoanalyst, Jedburgh/Edinburgh, Scotland. Member of the Philadelphia Association, London and College of Psychoanalysts-UK. Author of Testimony of Experience: Docta Ignorantia and the Philadelphia Association Communities (2014) and contributing author to R.D. Laing: Fifty years Since the Divided Self (2012), both published by PCCS Books Ltd.

Scottish Mental Health Awareness Week (4-10 October) is fast approaching and the expression “mental health” will be used by the majority involved in the debate. However, the use of this term is not a benign practice and therefore should not be left undisturbed or unchallenged. “Mental health” is a phrase everybody uses without thinking. The phrase seems harmless; how can two little words be of any consequence, derail a leftist critique of capitalism, or even back up the system the left intends to critique? I want to be clear however, although I am critical of the term “mental health”, I am in no way diminishing the mental distress that people experience. However it is important to recognise how the use and consequences of the term “mental health” does detract from the real suffering of people.

When one uses the term “mental health”, in a context where it means everything (e.g., concerning mental distress) the concept of health and ill-health subsumes the all of the context. However, the concept has so much slippage when subjected to a detailed critical analysis, it deteriorates into a phantasm that continually haunts in the background, because the concept cannot contain or represent in an ideal way, when it reduces or reifies human experience in such a way.

Activists from all political persuasions often put forward ideas concerned with campaigning for more or better “mental health” services, getting more CBT (cognitive behavioural therapy), or sometimes the more economically viable computerised version of CBT. To my mind this reeks of neoliberalism; there is, from “mental health” activists almost no interrogation of the concept of “mental health” from a critical psychoanalytical or philosophical perspective. The uncritical acceptance of such a term may seem harmless, but that is the ruse which capitalism wants to play to trick us.

The blatant missed trick regarding the cultural hegemony of “mental health” by the so-called radical left is startling as is the thoughtless core demand of good “mental health” from the state The acceptance of a Gramscian “common sense” (e.g., alienating/mystifying ideology, see Gramsci, 2003) and the demands for a master, or treats from a master in terms of idealist ideas of happiness or “mental health” is conspicuous as is the utter lack of campaigning against the “mental health” regimes that are being imposed on the most oppressed in our country.

The confusion, and subsequent alienation that the ideology or discourse of “mental health” brings to our psychological reality is compounded and perpetrated by the discipline of psychology, which purports to be a neutral science. As Boym (2010) argues, psychology, rather than contesting alienation and confusion which is the cultural hegemony of “mental health”, psychology exacerbates alienation and moves to celebrate them in a positivist ‘carnival of inauthenticity’. Alienation from ourselves is positively encouraged through psycho-biological frameworks (including genetic theories) which permeate the discipline of psychology and dispute and destabilize ideas of free will and responsibility. The crux of this matter is, under psychology, human beings are purported to be machines, and machines become faulty and need fixing. But, we are not machines in this sense. The “mental health” system and its institutions play a pivotal role in shoring up and defining our psychological lives which underpins acceptance of capitalism.

Allan Francis, the former lead editor of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 2013)-the book which gives our present culture all the labels we use when it comes to “mental health” is highly critical of the validity and reliability of such DSM disorders and if the method of DSM disorder creation was to be used with physical disorders, it would be rejected whole heatedly by the medical community. The basic categories of mental disorder which are outlined in the DSM have not been arrived at through painstaking research, but through the operation of committees. Practitioners cannot decide with any consistency who or who does not have a constructed disorder. A good example is schizophrenia where research shows that barley half of highly trained psychiatrists and practitioners schooled in the medicalisation of mental disorders believe in the label. It is a hypothetical disorder for which no medical tests exist and mental health practitioners cannot agree on its diagnosis. Worse still, the operation of these committees has been thoroughly corrupted by the influence of the pharmaceutical industry. Strong financial ties have been identified to operate between pharmaceutical companies, and those who are responsible for developing the diagnostic criteria for mental disorders (See Greenberg, 2011; Kutchins & Kirk, 2003).

One needs to be aware that the function of psychology and psychiatry within a capitalist system is to expand the categories of the “mental illness” thereby creating consumers of psycho-pharmalogical products, and “service users” of state sanctioned psychotherapies of adaptation, therapies which are sanctioned by the capitalist state on the basis of propping up the cultural hegemony of “mental health”. This system creates fear and submission to an ideology which controls and mystifies the masses.

Marx (1973) recognised this assault of alienation and mystification upon the subject. Marx theorised that the proletariat under capitalism is no longer a subject. Under capitalism, the subject is not permitted (e.g., we cannot free associate); the subject has to produce good “mental health”, positive cognitions etc; a perfect foreclosure of free subjecthood and of uncertainty; an uncertainty which needs to be, as language and reason cannot contain all of the truth of what it is to be human and to live; capitalism transforms the labouring power of the subject into an object; objectifying and reflecting the ‘scientific knowledge’ of our epoch, to abide by pseudo-scientific truths of what is “mental health” and what is not.

Let me be clear, it needs to be understood that there is no good evidence to suggest that there are any biological deficits, genetic abnormalities, or chemical imbalances related to mental ill-health or mental disorders. The evidence base for “mental illness” is so poor. There are no medical tests a physician can give you to test for a mental illness. And just to add, like the poor science of the taxonomy of mental disorders (e.g., DSM, 2013), psychometric tests of “mental health” problems do not validate the truth of having a so-called mental disorder. The work of Mary Boyle (2002) on Schizophrenia, David Healy (2003) and Irvine Kirsch (2009) on depression and SSRI antidepressants, Joanna Moncrieff (2003) on so-called biochemical imbalances in so-called mental illness, and Kutchins and Kirk (2003) on the mythology, nosology and taxonomy of mental disorders, shows well enough that the cultural hegemony of “ mental health” from a medico-biological perspective is a myth, and perpetrated by corrupt drugs companies and people with vested interests in the “mental health” industry.

The advent of the UK’s state sanctioned IAPT services (Improved Access to psychological therapies) which makes CBT more widely available (to the determent of more subversive psychotherapies) is primarily designed to get people back to work, functioning well enough to fit in with capitalist and neoliberal ideas of normality, positivity, and well-being. A darker shadow has been created with this cognitive revolution where the Department of Work and Pensions are now using CBT and other psychocoercive techniques to get unemployed people back to work. This latest development is in effect sanctioning the idea that the fault of being unemployed lies with the individual, not with the political and economic conditions that create unemployment and misery. Further, there is more and more evidence accumulating that CBT is nothing more that quick fix. As outlined in Shedler (2015), in controlled scientific studies the positive effects of CBT post 1 year after treatment has ended only endures in 5% of people that are treated. In essence, the hypnotic effects of willing oneself to see the positive wears off. One has to realise that the whole fundamental foundation of CBT rests upon a mystification. One of tenets of CBT is to target dichotomous thinking; in other words to help people out of black and white thinking. For example, I am unsuccessful vs. other people are successful and I am a failure vs. other people are not failures etc. However, theoretically, CBT is built upon the very foundation of dichotomy. It is built upon the foundation that there is such a thing as mental ill-health versus happiness or well-being, and, that there is a “good” way to think versus a “negative” way to think. This is a philosophical tautology which infects the very nature of the context in which CBT is delivered and received. Can not believing in the theoretical tenets of CBT’s notions of dichotomous thinking (or the concept of mental health) not be a positive thought which ameliorates “depression”?

The blatant missed trick regarding the cultural hegemony of “mental health” by the so-called radical left is startling as is the thoughtless core demand of good “mental health” from the state The acceptance of a Gramscian “common sense” (e.g., alienating/mystifying ideology, see Gramsci, 2003) and the demands for a master, or treats from a master in terms of idealist ideas of happiness or “mental health” is conspicuous as is the utter lack of campaigning against the “mental health” regimes that are being imposed on the most oppressed in our country. I think we could learn from Nietzsche’s writings on what he called the religion of comfortableness, the rush to prematurely extinguish another’s pain, which in our modern day malaise is called “mental health”. Nietzsche wrote:

…if you refuse to let your own suffering lie upon you for even an hour and if you constantly try to prevent and forestall all possible distress…..it is clear that besides the religion of pity you also harbour another religion in your heart….the religion of comfortableness”…“How little you know of human happiness, you comfortable and benevolent people, for happiness and unhappiness are sisters and even twins that either grow up together or, as in your case, remain small together.”
(Nietzsche, 1974, p. 269-270).

The philosopher Gilles Deleuze argued that philosophy should create a necessary disturbance contra the mystifying totalisations of state philosophy especially in matters of the psyche (see Nichterlein & Morss, 2016). The quote by Nietzsche above often disturbs. This is a good thing; we should all aim to be disturbed and not shy away from being disturbed. Disturbance is just the start. If one “listens” to the disturbance and goes with it, then the necessary critical work begins. Too often disturbance (philosophically) is covered up to protect sensibilities and/or a dogmatic “truth” is countered against the disturbance. This perpetrates what Deleuze would argue is, contra to true human becoming, so common in societies of control and state philosophy.

***

References.
Boyle, M. (2002). Schizophrenia: A scientific delusion? 2nd Edition, Oxford: Routledge.
Boym, S. (2010). Another freedom: the alternative history of an idea. London: University of Chicago Press.
Diagnostic and Statistical Manual of mental Disorders: Fifth Edition (2013). American Psychiatric Association.
Gramsci, A. (2003). Selections from prison notebooks, Q. Hoare & G.N. Smith (Ed. & Trans). London: Lawrence and Wishart.
Greenberg, G. (2011). Inside the battle to define mental illness. Wired Magazine. Retrieved from: www.wired.com/magazine/2010/12/ff_dsmv
Healy, D. (2003). Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychotherapy and Psychosomatics, 72, 71-79.
Kirsch, I. (2009). The emperor’s new drugs: Exploding the anti-depressant myth. London: The Bodley Head.
Kutchins, H., & Kirk, S.T. (2003). Making Us Crazy: DSM – The Psychiatric Bible and the Creation of Mental Disorders, Washington D.C. :The Free Press.
Marx, K. (1973). Grundrisse: Foundations of the critique of political economy, M. Nicolaus (Trans.). London: Penguin.
Moncrieff, J. (2003). A comparison of antidepressant trials using active and inert placebos, International Journal of Medicine, 12, 117-127.
Nichterlein, M., & Morss, J.R. (2016). Deleuze and psychology: philosophical provocations to psychological practices. London: Routledge.
Nietzsche, F. (1974). The Gay Science, W. Kaufmann (Trans.). Ontario Canada, Random House.
Shedler, J. (2105). Where is the evidence for “evidence based” therapy? The Journal of Psychological Therapies in Primary Care, Vol. 4, May 2015: pp. 47–59.

Notes.

i A longer and more comprehensive version of this article appeared as two-part podcast read by the author. The podcasts can be listened to in full here: www.ungagged.podbean.com.

Comments (23)

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  1. Coinneach Caimbeul says:

    Funny, the mental health service delivery as well as definitions of what connotes mental illness in the more “socialist” countries should be ten times more alarming.

  2. Neil Anderson says:

    So, in short; pharmaceutical companies (capitalist entities) depend on us to believe that we are mentally ill in order to make a profit. Yes, obviously.
    The political left have missed a trick by not challenging this. Yes, obviously.
    People are not to blame for being driven mad by the capitalist system. Yes, obviously.
    Many thanks for the news.

    1. Fiona Sinclair says:

      Yes – as the mainstream media routinely fails to cover any of this, it most certainly is, to most people.

  3. Alan McManus says:

    Robert M Pirsig in ‘Zen and the Art of Motorcycle Maintenance’ (1974) and ‘Lila’ (1991) reflects on his own experience of insanity and concludes that a problematic intellectual and social phenomenon cannot be either comprehended or resolved by a purely biological strategy.

    1. Fiona Sinclair says:

      Except it isn’t a `biological strategy` – http://cepuk.org/unrecognised-facts/

  4. Frank says:

    I’m not sure what to make of this article. In regards to style, highly decorative language and the name dropping of philosophers started to grate. It read as if were a literature review of what leftist philosophers say about mental illness. There were some interesting points although the author (in my opinion) comes close at times to arguing that mental illness is a socially construct, a claim which I find problematic. The problem with the anti-psychiatry movement as it used to be called in the 60s, was that authors such as Laing and Foucault (who surprisingly is not mentioned here) provide a useful critique of the social conditions that cause mental illness – but stray too close to an extreme social constructivist position. Steven Pinker’s The Blank Slate provides a useful and convincing critique of the social constructivist position on mental illness.

  5. joe kane says:

    By a strange coincidence, the £5 million PACE trial, mostly funded by the Labour Govt DWP and the only medical experiment ever to receive DWP money (and also money from the Scottish Chief Scientist Office), is being definitively exposed as an international medical fraud.

    PACE was designed to show that CBT and GET (Graded Exercise Therapy) were effective treatments for the patients suffering ME. After a long legal battle with the Queen Margaret University London, the host university of the DWP psychiatrists responsible for designing and running the PACE medical experiment, it was finally forced to release its experimental data.

    Turns out the claims made by these DWP funded medical scientists, in the likes of The Lancet, that CBT (in this case a form of brainwashing vulnerable chronically ill patients to ignore their symptoms and pretend to themselves they’re not really ill or disabled and get them to carry on working and not apply for disability benefits) were not supported by even their own unethical and unscientific manipulated standards and experimental gerrymandering.

    The DWP’s attempt to prove that ignoring physical illness and disability and concentrate on “functional” assessments of disabled people (ie its not what you can’t do, its what you can) has failed. PACE will have to be retracted. However the DWP will continue persecuting disabled people using its unscientific and unethical ‘biopsychosocial’ ESA assessments run and managed for them by the British medical profession which has turned a blind eye for years now to the harms and deaths of vast numbers of patients after being seen by registered medical professionals working for the Atos, Maximus etc.

    ps
    New book just out from long-time disabled activist and academic Mo Stewart investigates the rotten and corrupt medical practices and psuedo academic medical science behind the neoliberal attacks on the human rights of chronically ill patients and disabled people –
    ‘Cash not care: the planned demolition of the UK welfare state’
    https://www.amazon.co.uk/Cash-Not-Care-planned-demolition/dp/178507783X/ref=sr_1_1?s=books&ie=UTF8&qid=1474644162&sr=1-1

    1. Fiona Sinclair says:

      Many thanks for this comment. Although the mental distress that Bruce Scott talks about is undoubtedly the reality behind the supposed `mental illness` that the mental health industry seeks to `treat` with powerful psychotropic drugs, and much of this may be caused by traumatic life experiences, there are `mental illnesses` that are undoubtedly physical in origin, but which the psychiatric industry would prefer to remain undiagnosed. After all, if you can force `treatment` on someone for 30 years, all the while claiming that the side effects from the drugs are a worsening of the original `mental illness`, you can make a hefty profit.

  6. Crubag says:

    It was Marxist regimes who did the most to politicise psychiatry. Before they collapsed you could be sectioned for believing in democracy.

    And the east bloc regimes were also much more work focused than the west. They had heroes of labour, we had footballers and lottery winners.

    And we still won. Which shows how bad central planning of the economy is.

    1. Frank says:

      The red baiting on these threads is really tiresome at times.

      1. Crubag says:

        Do you think the Marxist states were right to use pyschiatry as they did?

        But there is an irony in that it was the lazy, indolent west, where not having to work is the dream, beat out the centrally planned cult of the workerm

        1. Frank says:

          No, the ‘Marxist’ states as you frame them were not right to abuse psychiatry as they did. I’m not sure what the point of that question is?

          1. Crubag says:

            My comments were twofold:
            – abuse of social sciences like psychiatry is not a product of neoliberalism only and the Marxism that the writer draws on for his critique did in fact spawn much more serious abuses. No one gets sectioned for not believing in a market economy.
            – the writer’s point that the neoliberals are using psychotherapy to get people fit for work is again trumped by the Marxist states
            There they actually had a cult of the worker, enforecable by gulag, compared to our culture’s admiration of those who have “made it” and don’t need to work.

            The writer uses the ideas of Marx and his followers as though they are the truth – forgetting that they gave their own history and proven failure.

            An academic critique, even if it favoured the Marxist analysis, would also have reviewed its own tools.

    2. Fiona Sinclair says:

      But you think it’s okay to be sectioned for just being disabled?
      `Autism and the madness of the Mental Health Act`:-
      http://newsnet.scot/citizen/autism-and-the-madness-of-the-mental-health-act/

      1. Crubag says:

        What are they asking for? It’s not clear from the article I’m afraid.

        1. Fiona Sinclair says:

          The author is asking the political left in this country to wake up to their own collusion and lazy acceptance of what the mental health industry touts as truth, but what is in fact lies, distortion, fraud, corruption and cruelty.

          I do take your point, and the point of others above, that the language and some of the references in the article are hard to understand and that it reads a bit like an academic text, but I certainly appreciate the fact that the author has laid out why the political consensus adopted by those who self-refer themselves as on the left of the political spectrum is so stupid – and, quite frankly, so utterly heartless.

          It would have helped if the article were not split between a preface that is clearly written by someone else (it refers to Dr. Bruce Scott in the third person), whilst the rest of the article is clearly written by Bruce Scott – but there is no acknowledgement of this in the article.

          Another bugbear I have is (financial constraints aside), that the proof reading of articles is terrible. I don’t imagine that Bruce Scott actually wrote `barley`, instead of `barely`, but it really grates to read this sort of thing, time and again, note only on Bella, but especially so on Commonspace as well.

          However, my own criticism of this article is that it panders to a very limited view of `mental illness`, and its own way reinforces the ignorant and patronising view that `mental illness` is a product of poverty, when it is not. That is undoubtedly due to the word limit placed on the article and because the author wanted to make a specific challenge, in a way that he hoped people who are politically literate would understand, by referring to the use of pseudo psychotherapies to coerce people back into the workplace, or to leave them feeling so oppressed that they end up taking their own lives.

    3. anna potrykus says:

      they weren’t marxist..they were stalinist…or state capitalist..and extremely repressive
      what we r going to now as a country is the over diagnosis of mental illness and the excessive use of tranquillisers..DHSS r demanding claimants undergo certain behaviourist training as a condition of benefit..’WE’ DIDNT WIN..children too r being wrongly diven drugs for AHD so that their parents can claim extra benefits..properly staffed offices and factories and family allowance at a adequate level might get rid of a lot of this disastrous and harming policy of drugging children..also carried out in schools by head teachers without the knowledge or agreement of their parents..also adults with special needs routinely drugged.

  7. Gareth Davy says:

    So much for ‘mental health’ care!
    After 10 years of supplying therapy sessions for the mental health organisation MIND, my therapy sessions have been axed. “No further funding”(???!!!!)

  8. David Kerr says:

    Lots of discussion here about Marxism and why the author’s analysis might not fit with historical Marxism and/or the problem of psychiatric and abuse is not specific to capitalism. Is the article pointing to a pure Marxist interpretation of mental health, historical and theoretical? I think not. Such binary thinking, either/or analysis points to a cultural hegemony of a type of thinking where the dialectic of thinking about this issue gets stuck. Such thinking is blind to the blind spots of its own thinking. Perhaps these are just tools to point out the fascism of control societies/state philosophy.

    1. Hunter Watson says:

      The essential point surely is that for hundreds of years people considered to have a mental illness have been subjected to a variety of inhumane “treatments”. The Scottish Government should, when it reviews Scottish mental health legislation next year, amend it in line with the Convention on the Rights of Persons with Disabilities and various court judgments, particularly relevant judgments of the European Court of Human Rights. Mental health patients who resist or object to the treatment should no longer be given ECT or held down by several nurses and injected with potentially harmful drugs.

  9. anna potrykus says:

    children r routinely drugged in schools ,overprescribed drugs for AHD and so too are adults with special needs in order to I’ve their often underworked cares an easy time o that everyone can”relax”
    in front of the television rather than go for a walk.

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