Reflections on the Privatisation of Mental Health

Allen Ginsberg’s (1984) poem, Howl, famously begins with the line:

‘I saw the best minds of my generation destroyed by madness.’

allen ginsberg
A young Allen Ginsberg (photo: youtube)

What we should glean from Ginsberg is that mental health is not simply an interior, it’s not an affliction of the deeper, inner, soul as much as a symptom of the society we live in. Suffering from bouts of mental illness himself as well as witnessing it being visited upon friends, Ginsberg deals with the issue with constant reference to 1950s American society. This is an important insight as Mental Health Awareness Week draws to a close. To concentrate wholly on the interior obscures the material and ideological structures that can initiate mental illness.

In stark contrast to Ginsberg, the contemporary debate on mental health seems to want to ignore or dismiss society entirely. It all becomes an issue for the private individual who must deal with it in ‘their own way’. It’s as if, to borrow Eagleton’s phrase (1991: 241), mental illness simply ‘drops from the skies’. The common view that notion that mental health is something that ‘can affect everyone’ (the presumption being it affects everyone equally) seems to somehow absolve the unequal, oppressive and stressful character of modern society. Mental illness can affect everyone but some are more at risk than others. Some are more able to access treatment than others.

The role of racism, poverty, sexuality or just the anxious, weird, cyber-fucked-world we inhabit cannot be ignored. Part of ending the stigma is the recognition that poorer sufferers, apart from the added stress of financial precarity, are unable to access treatment quickly and without financial cost. Go and see how long the local NHS waiting list for mental health treatment is in your area. The recognition that people of colour and LGBTQ+ people are more at risk is also required. Furthermore, there must also be a recognition that neoliberal economics requires a credit market which inflicts the mental distress of astronomical debts onto the general population (Harvey 2010: 17). Household debts are a record high in the UK right now. As Dawn Foster wrote in the Guardian, interventions from Royals and the like obscure the fact that the austerity policies of the Conservative Party have hollowed out the welfare state and the health service and exacerbated the conditions in which mental illness can fester. Warnings from mental health professionals have been ignored, even as the situation has worsened and suicides increased throughout the coalition government’s tenure.  The headline of a well-argued piece put it nicely:

‘Making efforts to break down the stigma around mental health means fuck all if there’s no funding’.

Similarly, research conducted by the homeless charity Shelter emphasise the disastrous impact housing pressures have had on mental health.

shelter
Infographic belongs to Shelter: http://england.shelter.org.uk/professional_resources/housing_and_mental_health?utm_source=twitter&utm_medium=referral&utm_campaign=MentalHealthEnter a caption

These housing pressures have been unaddressed by Tory governments keen to keep property prices high for the benefit of their property-owning members and voters. Even social media apps like Instagram, with its emphasis on ideal body types, have been shown to be harmful to young minds. Without the recognition of these societal factors, the issue becomes depoliticizes or ‘privatised’. Racism, poor housing, cuts to healthcare and welfare, toxic societal conceptions of gender roles and astronomical (student) debts have created a climate in which people can see no way out. Material and social circumstance cannot be ignored. As Megan Nolan wrote in Vice:

‘According to the symptom checklist, I suffer depression and anxiety. But even so, I couldn’t stop myself from saying to my doctor: I don’t think this is because I’m depressed. I think it’s because I’m poor. My anxiety about being poor makes it impossible to work, which makes me poorer, and the cycle continues.’

Mental health, in other words, is a political issue, not a private one we simply need to ‘destigmatize’. More needs to be done.

Before proceeding it’s worth noting the following: this piece simply wants to convey some reflections on mental health with a historical and literary perspective. It’s intent is to revaluate and politicize discourses of mental health, to illuminate historical perspectives that may have otherwise been in left the dark. Walter Benjamin (1973: 57) wrote that: ‘For every image of the past that is not recognized by the present as one of its own concerns threatens to disappear irretrievably.’ It is in this spirit that the piece proceeds.

Before his recent and tragic suicide, Mark Fisher wrote about the important task of politicizing mental health. He wrote (2009: 21) that capitalist societies sought to ‘privatise’ mental illness:

‘as if [it] were caused only by chemical imbalances in the individual’s neurology and/or by their family background – any question of social systemic causation is ruled out.’ [my emphasis]

Mental illness and its proliferation among the younger generation and the treatments have been ‘medicalised’ as a ‘chemical imbalance’, yet it’s easy to see the benefits of this for capital. Individuals automatically blame themselves, thinking: ‘it’s all in your head’. It’s as if the external world the society we live in is completely irrelevant to the workings of your own mind. As Fisher acknowledges (2009: 21), depression is caused by a lack of serotonin but is it a stretch to imagine the society we live in might have something to do with that? Or, to take the point further, is it a stretch to wonder whether society’s response to mental health can often tell us more about society than it does about our own brains?

Foucault argues (1971), for instance that even the rational, scientific study of mental health as a phenomenon was a result of the contingent social and economic circumstances of modernity. His Madness and Civilisation (1988) elucidates the extent to which mental illness has been interpreted through various ideological frames throughout history. In the Renaissance, the mentally ill were afforded knowledge beyond the sane’s comprehension. In many cases, they were revered as an expression of the limits of human reason. In the modern era, the mentally ill have been rationalized, hospitalized or taken out of society all together. Many found themselves entrapped in what Foucault (1988: 38) called ‘the Great Confinement’ including ‘one out of every hundred inhabitants of the city of Paris’ who were forced to endure ‘arbitrary measures of imprisonment’. Foucault (1988: 45-46) explains how across Europe, workhouses, ‘hospitals, prisons and jails’ could ‘contain those condemned by common law, young men who disturbed their families’ peace or who squandered their goods, people without profession, and the insane.’ This continued into the 20th century. Opened in 1904, Storthes Hall near Kirkburton in Huddersfield had women who’d had children out of wedlock also confined within its walls. In many cases, the poor were conflated with mentally ill as ‘pauper lunatics’ they were treated as one and the same. Storthes’s Hall’s records are rather cryptic and antiquated but they give you a flavour for what could land you inside:

‘Domestic trouble 14

Mental anxiety and worry 27

Intemperance in drink 14

Adverse circumstances 5

Religious excitement 2

Fright and nervous shock 1

Self abuse (sexual) 3’ (Littlewood 2003: 29)

What this illuminates is how political and historically contingent the position of the mentally ill is. Apart from this, it also attests to the shaky foundations that uphold the relationship between the ‘mad’ and the ‘civilised’.

Another mentally ill contemporary of Ginsberg and Foucault was Sylvia Plath. As a woman, Plath offers us another avenue through which we can study mental illness and the societal response to it. The patriarchal character of 1960s society was also a key factor in triggering Plath’s mental illness and her eventual suicide. The Bell Jar’s (1966) political message may be far subtler than Ginsberg, Fisher or Foucault but its existence cannot be denied. She recalls how her university required nude photos from its female students and was more like a finishing school which tried to turn into students into nice ladies than critical and thoughtful creators and innovators (Plath 1966). Another particularly repugnant, all too real passage recounts a case of rape (Plath 1966). Recent revelations also reveal her entrapment in an abusive relationship with fellow poet Ted Hughes, inspiring such classic poems as ‘The Jailor’ which compared the husband to a prison guard (Plath 1965). Hughes and Plath separating after the former’s infidelity was revealed and Plath’s mental health worsened. The pills Plath was proscribed in winter 1963 – monoamine oxidase inhibitor – would never be given dished out to anyone with suicidal tendencies now since they can cause hyperactivity. This contributed to her eventual and infamous suicide in the gas oven of her London abode. Thus, once again Plath’s mental illness cannot be separated from the society in which it manifested itself.

To further explore mid-to-late twentieth century’s conceptions of mental illness, it’s worth retuning to Ginsberg. ‘Howl’ (1984) has themes of repressed sexual identities, particularly homosexuality. There’s references to men with ‘big pacifist eyes sexy in their dark skin’ and those ‘who let themselves be fucked in the ass by saintly motorcyclists, and screamed with joy’. Howl is to Ginsberg in many ways a stream of consciousness. A consciousness that society, refused to let him have: it was still illegal to have or even talk about homosexual sex in public in the UK and the United States. The poem was banned in many places and Ginsberg was taken to court for writing it. Foucault was a contemporary of Ginsberg, a homosexual with a preference for sado-masochism. Much like Ginsberg, Foucault repressed his sexuality during his adolescence and in turn developed mental health problems which would come and go throughout his life. Much like Ginsberg, Foucault would often self-medicate hard drugs as a way of dealing with his condition. Having grown up in a nice bourgeois household, his family could afford to send him to one of the best psychiatrists in France, Jean Delay at the Hopital Saint-Anne in Paris. At the root of his mental illness though, which was ‘medicalized’ and ‘biologized’ by his visit to a medical professional, was French society’s less than tolerant approach toward his own homosexuality. In a later debate with Chomsky, Foucault said (1971):

‘Psychiatry, for instance, is also apparently meant to improve mankind and the knowledge of the psychiatrists. Psychiatry is also a way to implement a political power to a particular social group.’

Like Ginsberg, for Foucault, society’s homophobia was a major motor in the acceleration of his depressive states. For both figures, binaries of sanity and madness, gay and straight was compounded by their self-medicated drug abuse. Put another way, the society they lived in basically treated homosexuality as if it was a mental illness. Statistics show that LGBTQ+ people today still disproportionately abuse drugs as a self-medication mechanism. The solution, for both Foucault and Ginsberg, was a politicization of mental health which is undoubtedly task of both ‘Howl’ and Madness and Civilisation. As Foucault explained (1971):

‘It seems to me that the real political task in our contemporary society is to criticise the workings of institutions, particular the ones that appear neutral and independent, and to attack them in such a way that the political violence will finally be unmasked so that one can fight against them.’

Political violence for Foucault is surely broadly defined. Violence is undoubtedly inherent in; refusing to sufficiently fund mental health services, cutting welfare payments to disabled people, denying financial assistance to the mentally ill, straddling swathes of population with vast amounts of debt and allowing discriminative attitudes to perpetuate and reproduce themselves etc. These policies show that the government is not simply a ‘neutral’ arbiter. Fisher also saw that emancipatory politics could illuminate the inadequacies in our approach towards mental health. Foucault, Ginsberg, Fisher, even Plath, recognised there was a false neutrality to debates surrounding mental health. This neutrality absolved society of the blame for its causation. Fisher writes (2009: 17), almost paraphrasing Foucault:

‘… emancipatory politics must always destroy the appearance of a ‘natural order’, must reveal what is presented as necessary and inevitable to be a mere contingency…’

Understanding mental health as a political issue can therefore emancipate us from the inadequacies of the status quo.

  • Benjamin, W (1973) ‘Theses on the Philosophy of History’. in: Illuminations. Edited by Arendt. Trans. Zohn. New York: Fontana Collins.
  • Eagleton, T (1991) Ideology: An Introduction. London: Verso
  • Fisher, M (2009) Capitalist Realism: Is There No Alternative? London: Zero Books.
  • Foucault, M (1971) ‘Human Nature: Justice versus Power – Noam Chomsky debates with Michel Foucault.’ Available – https://chomsky.info/1971xxxx/
  • Foucault, M (1988) Madness and Civilisation: A History of Insanity in the Age of Reason. New York: Vintage Books
  • Ginsberg, A (1984) ‘Howl’ in Collected Poems, 1947-1980. New York: Available –

https://www.youtube.com/watch?v=WkNp56UZax4

  • Harvey, D (2010) The Enigma of Capitalism and the Crises of Capitalism. Oxford: Oxford Books
  • Littlewood, Ann (2003) Storthes Hall Remembered. Huddersfield: University of Huddersfield
  • Plath, S (1966) The Bell Jar. London: Faber and Faber
  • Plath, S (1965) London: Faber and Faber
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