The Crisis as a Problem of and For Mental Health
Many mainstream studies are now relating mental health problems, including rising suicide and alcohol-related death rates, to the present economic crisis. However, they usually fail to question the social system that has caused the crisis and, indeed, tend to seek solutions to mental health problems within the selfsame system. The problem of mental health today is not a matter of people getting depressed because of a flawed system that can be tweaked slightly in order to fix things. The social system itself is completely insane. Awareness of reality and, accordingly, of one’s essential needs, is the bedrock of mental health. So, too, are thinking realistically about our social circumstances and being able to function, personally and collectively, with autonomy, solidarity and enjoyment. Yet, these capacities tend to fail when a ruling minority imposes psychopathic and addictive ways of functioning which create a society that is well on the way to self-destruction because it attacks the great majority of its own members.
In the economic realm, this crisis is the all-too predictable result of fraudulent operations carried out by bankers and financiers trafficking in intangible financial products and counting on the blind faith of investors. The speculative bubble grew and grew until it burst and everyone was left to face the consequences of generalised public and private debt. Hardly anyone was aware of the situation or tried to stop it. The powers-that-be encouraged it. The madness of the neoliberal sect is clear when its apostles claim that they don’t fear the effects that crazy or depraved decisions might have on the system because “the market” will iron out any creases, or that setting legal limits to the accumulation of wealth impairs the proper functioning of the “economy”, when it is so evident that this oikonomia (originally “household management”) is undermining the interests and health of the whole human family.
This crisis has shown yet again how difficult it is to go against the flow of conventional wisdom. It may be an economic crisis but it is also a tremendous failure of rational thinking. For the crisis to have happened, unthinking faith in the system was required. Critics and whistleblowers became enemies of the state. Everyone was sucked in. Quite apart from the distress of its victims this neoliberal system is a mental health problem, for itself and for everyone, because of:
* people who make the big economic decisions, and their “scientific” advisers who wilfully or blithely ignore the precipice yawning at their feet;
* the institutions and political parties which, having benefitted from the immediate largesse of speculation, scurried to remove the legal limits imposed – following the Crash of 1929 – on monopolistic activity and simply ignored humanity’s huge and pressing social, ecological and cultural problems as if they had suddenly been erased, or didn’t matter;
* the general population, in being seduced by the illusion of easy riches, turning to individualism, and shunning solidarity and joint efforts to create a sustainable, just world.
The economic, political and ideological responses to the crisis are posited on continuation of everything that caused it in the first place. The pundits now dictating economic policy are the same and so are the parties in power. There has been no self-criticism and no thought of any change of direction. In neoliberal Europe (once called the Europe of peoples), the economic measures being imposed are not aimed at reactivating a productive economy in the citizens’ interests but at debt recovery, feeding the banks and the plundering of countries. The lies and arrogance of the powers-that-be are markedly psychopathic. For them, human beings have no value unless it is to further enrich the rich or as a source of ever-cheaper labour.
This crisis is also a crisis of identity – of personal and collective alienation – if we understand by “identity” the way we see ourselves, our elected leaders and our fellow citizens. It has laid bare the failure of the “democratic” system of representation in which blatantly corrupt ruling parties operate by means of secretive decisions, make the citizens pay for their crimes and folly and limit them to voting (or not voting) every four years, thus ensuring that they will abstain from any meaningful participation in matters that affect everyone. How represented does a jobless person feel by politicians whose first “solution” to his or her problems is to cut welfare provisions and health, education and social services, or by the Spanish MP Andrea Fabra whose response in parliament to the cutting of unemployment benefits was !Que se jodan¡ (“Fuck them!”)? And what about all the lies they’re telling? What about the sadism? All of this is a serious, systemic problem of the mental health of society as a whole.
Ill-treatment usually causes anxiety and submission in the victim. The problem is that fear – a necessary feeling associated with objective and/or subjective danger – is labelled as mental illness, and apprehension as “depression”, the victim’s problem. The “market” has an answer: pills aplenty for the victim and his or her ailing identity. In this demented world, the psychopath making antisocial decisions, who feels no guilt, is considered to be in good mental shape. Any notion of mental suffering as a natural response to a social problem is medicalised and thus dismissed because discussing it as such would entail questioning the very foundations, values and ethics of society.
The victims of the crisis constantly find that, in their search for work or help, nobody gives a damn. Like many excluded and ill-treated people, they cut themselves off from the world and feel ashamed and guilty about their fate. Some fall ill. However, what they need most of all is personal empowerment, which means having moral authority, being able to think for themselves, recovering their free will from the unworthy system that has appropriated it, and acting as citizens in the most civic sense of the word. Some people try to cope with fear and uncertainty by asking for help, contacting others who are in the same situation, learning with them how to recover their dignity and trying to free themselves from the subjugation of social exclusion. These are processes that, sufficiently extended – as in the case of groups and organisations combating gender violence against women – could eventually change political culture, the law, the economic reality and the mental health of the society.
In our interdisciplinary work in Barcelona with a group of people who have been unemployed for a long time we see very clearly how they experience their situation with a mixture of feelings of injustice, guilt and anger and, in particular, overwhelming insecurity, isolation and despair. Some defence mechanisms marshalled against these painful feelings and their concomitant effects on family and social relationships take the form of trying to avoid facing up to the horrible situation by taking refuge in a passive, infirm, fragile identity. Other healthier responses to anxiety include confronting the causes of the pain and accepting the need to do so by means of:
* seeking help and understanding as a way of combating the prevailing sadism and despair;
* group sharing and elaboration of the experience in order to avoid mental vacuity, resort to alcohol or withdrawal;
* constructing spaces for working together in seeking employment, creating self-help networks, etc.
In our work we focus on the ways in which different spheres of life are affected in terms of work, poverty, social relations in a generalised culture of abuse and impunity, and the risk – encouraged by populist politics – of “identifying with the aggressor” and turning hatred against even more vulnerable people, including children, women and immigrants. The family is the great “container” and support for affected people, but it is also prone to excessive tensions when denied support from society. Fortunately, the crisis, unemployment, evictions et cetera have also given rise to groups that offer help and foster awareness beyond individual problems, making visible what is invisible, moving from the individual to the collective dimension, and turning this perception into action so as to intervene in and change the conditions that cause the problems. Each of these institutions might be seen as a microcosm of the sane society we need to have if the population is to enjoy good mental health.
Many people are aware of the fast-growing statistics representing such mental health problems as depression, alcoholism and suicide. Much lesser known are the sharply increasing numbers of healthy people who are being treated for false mental health problems. In 2007, before the onset of the crisis, an official study on mental health in Catalonia (DASMAP, 2007) found that 26% of the population was being treated in primary health care for non-existent mental health disorders. The results of the study which, unsurprisingly, were not widely publicised, alert us to a massive “psychiatrisation” of the population. Indeed, there seems to be a general trend of over-prescription of anxiolytics, especially in economically depressed areas, which is now even being reported by such newspapers as the Daily Mail which, in June 2013, noted that one in six inhabitants of the Welsh town Blaenau Gwent (population 60,000) are on antidepressants. Wales, hard hit by the crisis, has the highest antidepressant use in the United Kingdom. In 2011, in England, there were 46.7 million prescriptions for a population of 53 million, which is to say 0.88 per person. The situation in the United States is similar (one adult in eight on antidepressants overall, and one in four women aged between 50 and 64). Spain and Catalonia lead the world in consumption of anti-depressives. In Catalonia, for example, there were 15.6 million prescriptions for anti-depressives in 2012, an average of more than two per person.
This is a bonanza for the big pharmaceutical companies which – aggressively pursuing neoliberal principles – finance clinical guides (endorsed, in Catalonia and elsewhere, by the public health authorities) suggesting that depressions are under-diagnosed. The intervention of big business in the mental health of entire nations is also an ideological and political struggle to enforce as “scientific” the biology-based views of the most reactionary sectors which label people and medicate them, while decrying as “unscientific” practices that seek to understand people from an interdisciplinary and community-based perspective (as upheld by the WHO).
In the United States, for example – and a similar process is observed in Catalonia – drug companies target an elite sales force of “key opinion leaders” (KOLs) who, through their writing and teaching, determine how mental illness will be diagnosed and treated. Marcia Angell writes in The New York Review of Books that of the 170 contributors to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 2000), “almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia”. Thanks to these KOLs, people seeking health care because they are anxious and upset, a very rational response to the economic and social difficulties caused by the crisis, are classified as “mentally ill”, drugged with far from innocuous addictive substances and rendered even less capable of facing individual and collective problems.
Perhaps the most distressing manifestation of all this is the shocking rise in the numbers of children diagnosed as mentally ill, some of them as young as two years old. The latest “illness” to have been “discovered” in this regard is “attention deficit hyperactivity disorder” (ADHD) and its variants, for which children (10% of adolescents in the United States) are treated with amphetamines which affect memory, cause insomnia, induce psychosis and are addictive. There is a clear class factor involved as Marcia Angell points out:
As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive. It is more generous than welfare, and it virtually ensures that the family will also qualify for Medicaid. […] But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. […C]hildren from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.
“Mental health” today is very different from the old paradigm of locking up disturbed people in lunatic asylums. Theoretically, a patient is someone with the same rights as anybody else, including the right to health care. However, the reality is that the prevailing quick-fix, commercially desirable option locks people away in iatrogenic prisons, creating even-more vulnerable individuals and a society with fast-growing numbers of “mentally ill”, dependent, infantile, drugged-out, docile people who can’t face up to problems, claim their rights or protest. This chemically induced passivity is very convenient for a sociopathic system like neoliberalism where people’s health – society’s health – is just another sphere of profitable business. Many public health officials have been lured away from their social responsibilities by the siren song of a highly restrictive, lucrative, technocratic model in which people, far from being cherished as members of the community, are “managed” as “clients” (to be taken advantage of). The neoliberal system not only causes social, and hence mental, distress but has invented illnesses that have turned mental health care into a vast market for peddling amphetamines and antidepressants. When mental health becomes technocratic, a mere appendage of the biotechnological industry, not only individuals but whole societies suffer. The key to individual and social mental health is human dignity and, for that to flourish, we need a very different kind of society from the one that neoliberalism has inflicted on us. Or shall we just renounce our human bonds, our principles and our values and let them have their way with us?
Dr. Lluís Isern is a member of the International Psychoanalytical Association.