Mental illness is now recognised as one of the biggest causes of individual distress and misery in our societies and cities, comparable to poverty and unemployment. One in four adults in the UK today has been diagnosed with a mental illness, and four million people take antidepressants.
‘What greater indictment of a system could there be,’ George Monbiot has asked, ‘than an epidemic of mental illness?’
The shocking extent of this ‘epidemic’ is made all the more disturbing by the knowledge that so much of it is preventable. This is due to the significant correlation between social and environmental conditions and the prevalence of mental disorders.
Richard Bentall, professor of clinical psychology at the University of Liverpool, and Peter Kinderman, president of the British Psychological Society, have written compellingly about this connection in recent years, drawing powerful attention to ‘the social determinants of our psychological wellbeing’. ‘
The evidence is overwhelming,’ notes Kinderman, ‘it’s not just that there exist social determinants; they are overwhelmingly important.’
A sick society
Experiences of social isolation, inequality, feelings of alienation and dissociation, and even the basic assumptions and ideology of materialism and neoliberalism itself are seen today to be significant drivers – reflected in the titles of a number of recent articles and talks on this subject, such as those of consultant psychotherapist David Morgan’s groundbreaking Frontier Psychoanalyst podcasts, which have included discussions on whether ‘Neoliberalism is dangerous for your mental health’, and ‘Is neoliberalism making us sick?’
Clinical psychologist and psychotherapist Jay Watts observes in the Guardian that ‘psychological and social factors are at least as significant and, for many, the main cause of suffering. Poverty, relative inequality, being subject to racism, sexism, displacement and a competitive culture all increase the likelihood of mental suffering.
Governments and pharmaceutical companies are not as interested in these results, throwing funding at studies looking at genetics and physical biomarkers as opposed to the environmental causes of distress.
Similarly, there is little political will to combine increasing mental distress with structural inequalities, though the association is robust and many professionals think this would be the best way to tackle the current mental health epidemic’.
There are clearly very powerful and entrenched interests and agendas here, which consciously or unconsciously act to conceal or try to deny this relationship, and which also makes the recent willingness amongst so many psychoanalysts and therapists to embrace this wider context so exciting and moving.
Commentators often talk about society, social context, group thinking, and environmental determinants in connection with mental distress and disorders, but we can I think actually be a bit more precise about what aspect of society is mainly driving it, is mainly responsible for it. And in this context it’s probably time we talk about the c word – capitalism.
Many of the contemporary forms of illness and individual distress that we treat and engage with certainly seem to be correlated with and amplified by the processes and byproducts of capitalism. In fact, you might say that capitalism is in many respects a mental illness generating system – and if we are serious about tackling not only the effects of mental distress and illness, but also their causes and origins, we need to look more closely, more precisely, and more analytically at the nature of the political and economic womb out of which they emerge, and how psychology is fundamentally interwoven with every aspect of it.
Perhaps one of the most obvious examples of this intimate connection between capitalism and mental distress is the prevalence of neurosis. As Joel Kovel, a former psychiatrist and professor of political science, notes:
‘A most striking feature of neurosis within capitalism is its ubiquity.’ In his classic essay ‘Therapy in late capitalism’ (reprinted in The Political Self), Kovel refers to the ‘colossal burden of neurotic misery in the population, a weight that continually and palpably betrays the capitalist ideology, which maintains that commodity civilization promotes human happiness’:
‘If, given all this rationalization, comfort, fun and choice, people are still wretched, unable to love, believe or feel some integrity to their lives, they might also begin to draw the conclusion that something was seriously wrong with their social order.’
There’s also been some fascinating work done on this more recently by Eli Zaretsky (Political Freud), and Bruce Cohen (author of Psychiatric Hegemony), who have both written on the relations between the family, sexuality, and capitalism in the generation of neuroses.
It is significant, for example, that one of the most prominent features of the psychological landscape that Freud encountered in late nineteenth-century Vienna were the neuroses – which, as Kovel notes, Freud saw as being entirely continuous with ‘normal’ development in modern societies – with much of these, he adds, being rooted in our modern experience of alienation. ‘Neurosis,’ Kovel says, ‘is the self-alienation of a subject who has been readied for freedom but runs afoul of personal history.’
It was of course Marx who was the great analyst of alienation, showing how capitalist economics generates alienation as part of its very fabric or structure – showing how, for instance, alienation gets ‘lost’ or ‘trapped’, embodied, in products, commodities – from the obvious examples (such as Nikes made in sweatshops, and sweatshops embodied in Nikes) – to a wider and much more pervasive sense that the whole system of production and creation is somehow alienating.
As Pavon Cuellar remarks, ‘Marx was the first to realise that this alienation actually gets contained and incarnated in things – in “commodities”‘ (Marxism and Psychoanalysis). These ‘fetishised’ commodities, he adds, seem to retain and promise to return, when consumed, the subjective-social part lost by those alienated while producing them: ‘the alienated have lost what they imagine [or hope] to find in what is fetishised.’
This understanding of alienation is really the core issue for Marx. People probably know him today for his theories of capital – how issues of exploitation, profit, and control continually characterise and resurface in capitalism – but for me the key concern of Marx, and one that is constantly neglected, or misunderstood, is his view on the centrality and importance of human creativity and productivity – man’s ‘colossal productive power’ as he calls it – exactly as it was in fact for William Blake, slightly earlier in the century.
Marx refers to this extraordinary world-transformative energy and agency as our ‘active species-life’, our ‘species-being’ – our ‘physical and spiritual energies’. But these immense creative energies and transformative capacities are, he notes, under the present system, immediately taken from us and converted into something alien, objective, enslaving, fetishised.
The image he evokes is of mothers giving birth – another form of labour perhaps – with the baby immediately being taken away and converted into something alien, something doll-like — a commodity. He considers what effect that must have on the mother’s spirit. This, for Marx, is the source of the alienation and unease, the sort of profound dislocation of the human spirit that characterises industrial capitalism. And as Pavon Cuellar shows, we can’t buy our way out of this alienation – by producing more toys, more dolls – because that’s where the alienation occurs, and is embodied and generated.
Indeed, consumerism and materialism are themselves widely recognised today as key drivers of a whole raft of mental health problems, from addiction to depression. As George Monbiot notes, ‘Buying more stuff is associated with depression, anxiety and broken relationships. It is socially destructive and self-destructive’.
Psychoanalytic psychotherapist Sue Gerhardt has written very compellingly on this association, suggesting that in modern societies we often ‘confuse material well-being with psychological well-being’. In her book The Selfish Society she shows how successfully and relentlessly consumer capitalism reshapes our brains and reworks our nervous systems in its own image. For ‘we would miss much of what capitalism is about,’ she notes, ‘if we overlook its role in restructuring and marketing desire and impulse themselves.’
Another key aspect of capitalism and its impact on mental illness we could talk about of course is inequality. Capitalism is as much an inequality-generating system as it is a mental illness producing system. As a Royal College of Psychiatrists report noted: ‘Inequality is a major determinant of mental illness: the greater the level of inequality, the worse the health outcomes. Children from the poorest households have a three-fold greater risk of mental ill health than children from the richest households. Mental illness is consistently associated with deprivation, low income, unemployment, poor education, poorer physical health and increased health-risk behaviour.’
Some commentators have even suggested that capitalism itself, as a way of being or way of thinking about the world, might be seen as a rather ‘psychopathic’ or pathological system. There are certainly some striking correspondences between modern financial and corporate systems and individuals diagnosed with clinical psychopathy, as a number of analysts have noticed.
Robert Hare for instance, one of the world’s leading authorities into psychopathy and the originator of the widely accepted ‘Hare Checklist’ used to test for psychopathy, remarked to Jon Ronson: ‘I shouldn’t have done my research just in prisons. I should have spent some time inside the Stock Exchange as well.’ ‘But surely stock-market psychopaths can’t be as bad as serial-killer psychopaths?’ the interviewer asks. ‘”Serial killers ruin families,” shrugged Bob. “Corporate and political … psychopaths ruin economies. They ruin societies.”‘
Pathological institutions in Capitalism
These traits, as Joel Bakan brilliantly suggested in his book The Corporation, are encrypted into the very fabric of modern corporations – part of its basic DNA and modus operandi. ‘The corporation’s legally defined mandate,’ he notes, ‘is to pursue, relentlessly and without exception, its own self-interest, regardless of the often harmful consequences it might cause to others.’
By its own legal definition, therefore, the corporation is ‘a pathological institution’, and Bakan helpfully lists the diagnostic features of its default pathology (lack of empathy, pursuit of self-interest, grandiosity, shallow affect, aggression, social indifference) to show what a reliably disturbed patient the corporation is.
Why should all of these contemporary social and economic practices and processes generate so much illness, so many disorders? To answer this I think we need to look back at the wider Enlightenment project, and the psychological models of human nature out of which they emerged.
Modern capitalism grew out of seventeenth century concepts of man as some sort of disconnected, discontinuous, disengaged self – one driven by competition and a narrow, ‘rational’ self-interest – the concept of homo economicus that drove and underwrote much of the whole Enlightenment project, including its economic models.
As Iain McGilchrist notes, ‘Capitalism and consumerism, ways of conceiving human relationships based on little more than utility, greed, and competition, came to supplant those based on felt connection and cultural continuity.’
We now know how mistaken, and destructive, this model of the self is. Recent neuroscientific research into the ‘social brain’, together with exciting developments in modern attachment theory, developmental psychology, and interpersonal neurobiology, are significantly revising, and upgrading, this rather quaint, old-fashioned view of the isolated, ‘rational’ individual – and also revealing a far richer and more sophisticated understanding of human development and identity, through increased knowledge of ‘right hemisphere’ intersubjectivity, unconscious processes, group behaviour, the role of empathy and mentalisation in brain development, and the significance of context and socialisation in emotional and cognitive development.
As neuroscientist David Eagleman observes, the human brain itself relies on other brains for its very existence and growth—the concept of ‘me’, he notes, is dependent on the reality of ‘we’:
We are a single vast superorganism, a neural network embedded in a far larger web of neural networks. Our brains are so fundamentally wired to interact that it’s not even clear where each of us begins and ends. Who you are has everything to do with who we are. There’s no avoiding the truth that’s etched into our neural circuitry: we need each other.
Dependency is therefore built into the fabric of who we are as social and biological beings, hardwired into our mainframe: it is ‘how love becomes flesh’, in Louis Cozolino’s striking phrase. ‘There are no single brains,’ Cozolino observes, echoing Winnicott, ‘brains only exist within networks of other brains.’ Some people have termed this new neurological and scientific understanding of the deep patterns of interdependency, mutual cooperation, and the social brain ‘neuro-Marxism’ because of the implications involved.
Capitalism is, it seems, rooted in a fundamentally flawed, naive, and old-fashioned seventeenth-century model of who we are – it tries to make us think that we’re isolated, autonomous, disengaged, competitive, decontextualised – an ultimately rather ruthless and dissociated entity. The harm that this view of the self has done to us, and our children, is incalculable.
Many people believe, and are encouraged to believe, that these problems and disorders – psychosis, schizophrenia, anxiety, depression, self-harm – these symptoms of a ‘sick world’ (to use James Hillman’s terrific description) are theirs, rather than the world’s. ‘But what if your emotional problems weren’t merely your own?’, asks Tom Syverson. ‘What if they were our problems? What if the real problem is that we’re living in wrong society? Perhaps Adorno was correct when he said, “wrong life cannot be lived rightly”.’
The root of this ‘living wrongly’ seems to be because we live in a social and economic system at odds with both our psychology and our neurology, with who we are as social beings. As I suggest in my book, we need to realise that our inner and outer worlds constantly and profoundly interact and shape each other, and that therefore rather than separating our understanding of economic and social practices from our understanding of psychology and human development, we need to bring them together, to align them. And for this to happen, we need a new dialogue between the political and personal worlds, a new integrated model for mental health, and a new politics.