The strange comfort of symptoms
Faced with mushrooming problems of mental ill-health, our societies have masked the problem by reclassifying symptoms as diseases with neurological causes. The task of understanding of how the organisation of society is at the root of many mental problems should be part of a wider effort to connect social malaises with their socio-economic cause. We should not exhaust ourselves in a ceaseless attempt to deal with symptoms.
The pervasiveness of mental distress in developed capitalist countries inspires two contrasting explanations from those sceptical of the somnambulistic reassurances of our corporate media. One is to assert that the pharmaceutical industry, having comprehensively infiltrated the medical and psychiatric professions, is now manufacturing diseases to match the drugs available. What used to be ordinary sadness has been rebranded as depression, an illness that can conveniently be combated by the dispensing of billions of pills to correct a chemical imbalance in the brain; a ceaseless process that coincidentally makes fantastic profits for big pharma.
The other reaction is to contend that neoliberal capitalism is indeed generating a “mental health plague”. The kind of capitalism, initially incubated by Anglo-American societies, but now spreading around the globe, is causing an acute intensification of emotional distress, depression, anxiety and personality disorder. Inequality, consumerism and an inescapable obsession with work are combining to produce an epidemic of mental ill-health. Pharma companies are merely cashing in on the ensuing wreckage.
But perhaps these two perspectives are not as far apart as they first appear.
According to the Belgian psychoanalyst Paul Verhaeghe, what has happened to the understanding of mental distress in recent years is that symptoms have started being reclassified as diseases.
One example is attention deficit and hyperactivity disorder. Because a child is hyperactive and has difficulty concentrating, they obviously have ADHD. The inference is always that because a disease has been diagnosed, the source of the problem must be neurological or genetic, and can be treated by drugs.
Verhaeghe says we are trapped inside circular arguments and pseudo-explanations: a person has ADHD because they have difficulty concentrating and are hyperactive and they have difficulty concentrating and are hyperactive because they suffer from ADHD. Breaking out involves accepting, in common with the British Psychological Society and the World Health Organization, that mental disorders are primarily caused by social factors.
This would lead into subversive areas. Can autism or schizophrenia really be seen as social disorders? There would be enormous resistance to this, not only from the psychiatric profession, but also from mental health patients themselves. In the UK, as in many countries, people with mental health problems have to fight to prove there is something medically wrong with them in order to receive welfare benefits. It would be a short step from emphasising the underlying social cause of many mental problems to affixing responsibility for the problem to the person suffering from it, or even denying there is anything fundamentally wrong with them.
Yet, because a disorder is classified a symptom, rather than a disease, a social rather than a genetic problem, does not make it any less real, or any easier to cure. Nor does it mean some people are not more genetically prone to suffer from it than others. A changed social environment will ameliorate mental health problems for some people. For others it will make no difference. But that is not the point. What this acknowledgement what do is allow the integral role of society in generating mental health or illness to be accepted. Then, the onus would firmly be placed on changing society, not altering brain chemistry or patterns of behaviour.
Every society, says Verhaeghe, generates mental illness as well as mental health. Historically, we are quite open to this idea. The Victorian age, with its strict moral codes and repressive sexual morality, produced hysteria in some women and obsessive-compulsive disorder in some men. Our current society generates disorders such as depression and anxiety among adults and ADHD and autism in children. But while we are quite able to look back with clarity on the deficiencies of past epochs, says Verhaeghe,“we are blind to what goes on in our own day and age.”
This is compounded by the neo-liberal insistence on the effects of mental distress, never the reasons behind it. “Sociological research has shown a clear link between the current socio-economic system and severe psychological and social problems,” writes Verhaeghe in his 2012 book, What About Me?, “The dominant neo-liberal mindset ignores this fact and, instead of tackling the causes, focuses entirely on the consequences: namely, the deviant, disturbed, and dangerous others – psychiatric patients, junkies, young people, the unemployed and ethnic minorities.”
The reason why western politics seems so immovably stuck on this and other issues, is that even enlightened critics who want to change society’s attitude towards mental illness cannot extricate themselves from this “dominant neo-liberal mindset”.
For “better mental health”
Consider the UK charity, Mind, which has as its tagline “for better mental health”. The charity aims to ensure everyone experiencing a mental health problem gets help and support and is a member of Time for Change, a coalition of charities that campaigns against mental health discrimination and stigma.
There is nothing wrong with any of this and Mind does important work trying to make sure people with mental health problems are not unfairly affected by the Work Capability Assessment and other benefit atrocities. But if you really want to achieve “better mental health” you have to extend your gaze immeasurably. You have to examine how the current organisation of work generates mental distress rather than mental health, how the claustrophobic inescapability of work coupled with ever-present disposability is a cause of both mental and physical illness, how inequality generates distress, and how the erratic quality of early childhood relationships incubates mental problems that emerge later in life.
And, in these times, you have to confront how the onslaughts of austerity are exacerbating or creating mental distress.
In other words, you would have to delve - as the twentieth century German psychoanalyst Erich Fromm did – into what brings about a ‘sane society’ and what causes its opposite. This would inevitably take you into controversial and difficult issues, such as how success in contemporary society is dependent upon the fostering of certain characteristics, such as (in Verhaehge’s words) “flexibility, speed, efficiency, result-orientedness and articulateness in the sense of being able to sell yourself.” And how the lack of these skills leads to self-blame.
But Mind and other mental health charities wouldn’t dare approach any of these issues. To do so would take you away from symptoms, which can always be ameliorated or looked upon in a different way, into the dangerously “political” waters of root causes. But because they are controversial and political is precisely the reason we need to go there.
As Verhaeghe readily admits, “finding evidence for the connection between a particular type of society and mental disorders is no simple matter”. He suggests that the spectacular rise of ADHD is connected to constant exposure to “information nuggets” such as text messages, tweets and keywords. There is no time to practice the art of concentration. This sounds plausible. But accepting this hypothesis then begs the question of why our work and free time is filled with so many distractions, why we are, in the words of David Harvey, “totally absorbed either in the pseudo busy-work of much of contemporary production or in the pursuit of alien consumerism.”
“Always connect”, said the early twentieth century novelist EM Forster. But most of the organisations that surround us are myopic when what is required is 20:20 vision. This narrow focus on symptoms is not limited to mental illness. When our political culture can bear to accept the reality of global warming, it becomes fixated on technological fixes that will give a spurt to economic growth. The root cause of the financial crisis becomes lost in attempts to eradicate symptoms such as unemployment or government debt.
Possibly, a compulsive need to always be occupied partly explains the compulsive attention on symptoms, because the symptoms will never go away unless you address the underlying disease. Maybe we want to permanently exhaust ourselves in trying to solve never-ending symptoms. I think Erich Fromm called it the fear of freedom.