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) Ariel. London: Faber and Faber

Review: Simon Armitage at the Brontë Parsonage Museum

The Unaccompanied

Simon Armitage (2017) The Unaccompanied. London: Faber and Faber

Simon Armitage (2017) Mansions in the Sky. Branwell Brontë Exhibit.Bronte Parsonage Museum. Haworth, West Yorkshire.

They say you should never meet your heroes but upon hearing the The Brontë Parsonage Museum was hosting Simon Armitage it was hard to resist. After greedily releasing two collections of poetry this week, his exhibit on Branwell Bronte, the ‘fail son’, opium-addicted, Bronte brother was also opened. His reading dealt with the complexity, speed and inequality of modern life, set against the background of West Yorkshire’s rolling Pennine hills. The eccentricity and telluric quality of Armitage’s writing was juxtaposed with the dizzying experience of the modern metropolis. You came away with a sense that this was a poet who, after translating and playwriting for many years, had come back to his stomping ground with a political point to prove.

Armitage filled the silences between his poems with a more improvised form of the wit we’ve come to expect from his prose works. Gig (2008), All Points North (1998) and Walking Home (2013) were written with what he describes as his ‘bleak sense of humour’. Yet he always manages to somehow keep it serious enough to avoid the trap of gimmick. Armitage typically combines hilarity with the dry and the dismal. ‘The Poets Hosts His Annual Office Christmas Party’, full of innuendo, is the stand out funny one of this collection. However, The Unaccompanied also demonstrates Armitage’s ability for a more systematic social commentary.

Reading in soft Huddersfieldian tones, he juxtaposes the rich with the poor, the rural with the urban and the tragedy with the farce. Armitage himself described the work as a ‘recession collection’, a ‘sociological’ recantation of British society since 2008. Or at least post-crash British society as he saw it through his gritty, Northern Realist lens. You can see where he’s coming from. It’s easy to think that in a decade where wage growth has been at its lowest since the invention of the steam engine, poetry is a self-indulgent piss-around for the moneyed-classes. Yet it remains as vital as ever.

Beginning with ‘Thank You For Waiting’, a satirisation not only of airlines but of the inequality engendered by neoliberal capitalism, he was subtle yet bitingly political. He amusingly portrayed the segregation of air travel by social class in the United States through the medium of substances from ‘Gold’ and ‘Silver’ to ‘Sweat’ and ‘Dust’. ‘Nurse at a Bus Stop’ speaks of a young woman who will always ‘hold the hand of cancer till the line goes flat’ even as the social and the political, indeed history itself, works against her. Risking being a ‘Jilted bridge of public transport’, she slogs every day to counter the ‘humanitarian crisis’ the Red Cross reported in British hospitals. The poem defended those who wear their NHS ‘fob watch’ as ‘a medal to your breast’. It vindicated those still left with the faith to fight for the NHS, even as successive governments have pulled the rug from under it. The audience’s collective murmur of miserable agreement capped off the poem, showing how well Armitage has managed to keep his finger on the public pulse.

In a sense, The Unaccompanied speaks for what has come to be known since Brexit as the communities left behind. That said, he’s not simply representing the Brexiteer. Rather his attention is on those left behind, socially and politically, in general. The clue here is in the title of the collection. We’re taken on a journey through almost anonymous West Yorkshire villages, to Poundland where we meet ‘a duty manager with a face like Doncaster’. Then there’s Wakefield Westgate railway station which recently moved, almost as if it was sick of being neighbours with the murderers and rapists that inhabit Wakefield’s high security prison. Armitage recounts his meeting with serial killer Robert Maudsley, which took place in earshot of the platform announcements, in ‘Solitary’. What comes through is Maudsley’s banality as well as his empty existence ‘in his glass case’. We are left pitying the life of those detained in solidarity confinement, if not Maudsley himself. Here we find that the miserable, macabre and mundane are transmuted by Armitage into the sublime.

His commentary on modernity steps it all up a notch. The Unaccompanied’s enigmatic and ambiguous cover itself is worth thinking about. When asked about it he recounts and explains the numerous and conflicting interpretations of the ‘cosmonaut’ set against the background of ‘embryonic pink’. Kept alive by a mechanic umbilical cord, it’s easy to relate to this anonymous, almost post-human figure, left stranded by the machinery of his own making. ‘The Emergency’s’ enigmatic last line ‘What is it we do now?’ is reminiscent of Marx’s definition of modernity: ‘All that is solid melts into air’. Perhaps the collection should be read as a search for solidity in a world of fluid and flux. ‘To-do-list’, the fastest poem he read, attests to this. A whirlwind of errands where to eat and breathe is ‘optional’, the poem’s theme of speed only seeks to reflect that of contemporary life. Similarly, ‘Old Boy’ reads like a rant from a Dad struggling to keep up with the news of the day, never mind technological advances. Yet we can relate to how the complexitity of modern life can make us feel like ‘a monkey with a jigsaw’. To appreciate the poem’s frustration fully, it’s worth listening to a fast-paced version from Armitage’s band, The Scaremongers, on the track ‘From the Shorelines of Venus’.

To celebrate the 200th anniversary of the birth of Branwell Brontë, Armitage curated an exhibit at the Bronte Parsonage Museum where we adjourned after the reading. Even in these poems he wrote for Branwell Brontë, Armitage can’t escape the 21st century frame. This would seem anachronistic if it wasn’t so plain funny. In one fail swoop Armitage bounces from Wordsworth and the Brontës, to The Smiths and Premier League football. ‘William, It Was Really Nothing’ recounts a letter Branwell sent to William Wordsmith, who was more than uninterested in writing back. Armitage can’t resist mixing the low and highbrow and he seems to work to cultivate an ‘everyman’ reading voice. Contemplating his self-worth, a 21st century version of the Bronte brother pontificates about Manchester United shelling out £85million for Paul Pogba. ‘Wallet’ continues the theme, empty but for a condom and coke-covered credit card, Branwell’s character is brought to life through the prism of 21st century.

Armitage’s modesty and humble beginnings in provincial West Yorkshire can disguise the intellectualism that lays behind his poetry. His translations of poems from Ancient Greece and the Middle Ages show how well-read his. No doubt he would deny this. He is keen to create space for interpretation of his work that is safe from academic literary theory. While it garnered a few laughs, his joking cry of ‘help’ at the prospect of giving a lecture at Oxford can’t help but seem insincere. Indeed, his lectures at Oxford reveal him to be an avid and wide-ranging reader. The beauty and hilarity of Armitage lies in his ability to talk about the Odyssey and Poundland, Brontë and Pogba as if they were one and the same. His subtle yet germane social commentary in this new collection shows he’s still got a few aces up his sleeve.

Armitage sits on the bed in Branwell’s Studio© at the Brontë Parsonage Museum, Haworth. Photographer: Simon Warner.

Armitage at the Bronte Parsonage

 

 

Ken Clarke is right, it’s not surprising the public are switched off by elections

As the UK 2015 General Election approaches, we are barraged with a set of candidates who, as always, ‘preen and smile and bring forth a shower of clichés with a solemnity appropriate for epic poetry’, as the late Howard Zinn once commented. The unpopularity of such candidates has been reflected in voter turnouts in Britain, which have been on whole decreasing: less than two thirds of the electorate voted in 2010 yet that was the highest turnout in a general election of the 21st century so far. There is also an undeniable correlation across the country in recent years between low voter turnout and poverty. The party most harmed by this was Labour, Blair’s centrist coup in 1997 and the consequent 13 years of ‘Third Way’ politics caused Labour to lose 5 million working class voters and forced members to leave in droves. In the 2010 Labour received the lowest share of the popular vote since 1918 and Scottish Labour in 2015 has been described as being ‘in meltdown’.

One of the overall reasons for this is because people are totally disillusioned by the political system, elections are fought less and less over issues which matter to people and more and more over the personality of the leader. Even at the heart of the Establishment, we had Ken Clarke, Tory cabinet minister for Thatcher, Major and Cameron commenting in The New Statesman

‘The public debate and the media, which is becoming increasingly celebrity culture, rather hysterical, sensational, and reduces the whole thing to theatre. Everybody’s election campaigns are presidential, everything’s attributed to the party leader. What matters is how the party leader eats a hamburger and all this type of thing. I mean, it does switch the public off.’

Clarke’s analysis seems on point, elections more than ever are based on the style and the personality of the party leader. David Cameron was recently filmed by The Sun, most of the footage concentrated on the Camerons having their breakfast at No.10 while trying their hardest to appear like normal people. Similarly, The Daily Mail interviewed Samantha Cameron for a personal insight into their family life, another clear attempt to humanize and normalise the Camerons. This ‘celebrity culture’ which has pervaded into the election campaigns is a symptom of our broken political system which breeds this ‘theatre’ kind of debate.

Paul Krugman touches on the economic aspect of this ‘theatre’ in his article in the New York Times where he refers to the ‘misleading fixation of budget deficits’, both Labour and the Conservatives have accused one another of making ‘irresponsible’ funding promises. Moreover, over the last five years the Conservatives, Liberal Democrats and much of the media have lectured us on the necessities of cuts while borrowing went up and the economy almost slumped into a triple-dip recession.

This is the dominant narrative Krugman was referring to –

“In the years before the financial crisis, the British government borrowed irresponsibly, so that the country was living far beyond its means. As a result, by 2010 Britain was at imminent risk of a Greek-style crisis; austerity policies, slashing spending in particular, were essential. And this turn to austerity is vindicated by Britain’s low borrowing costs, coupled with the fact that the economy, after several rough years, is now growing quite quickly.”

Tories to match labour spendingBut this is simply not true. In 2007, George Osbourne said he would match Labour’s spending over the next three years, despite the fact that now he claims Labour overspent. Britain was nowhere near the so-called ‘Greek style-crisis’ and no other economy which borrows in its own currency was liable to such a crisis. Furthermore, the only reason the economy has now tenuously recovered is because Cameron held off reams of planned spending cuts. As Krugman points out-

‘if this counts as a policy success, why not try repeatedly hitting yourself in the face for a few minutes? After all, it will feel great when you stop’.Tories to match labour spending 2

While unemployment is decreasing, the jobs the coalition congratulates itself on creating amount to low-wage, low-skilled jobs and zero hours contracts. The ‘recovery’ narrative ignores the fact the coalition presided over the biggest decrease in average living standards for over 100 years. Meanwhile, the extremely rich, the so-called ‘wealth creators’, have benefited significantly and even received nonsensical tax cuts.

Unsurprisingly, this inequality comes at a price, The Telegraph and The Guardian reported that the life expectancy in Britain’s poorest areas is worse than Rwanda and on par with Botswana. This reality is completely ignored by the established narrative: ‘the recovering is working’, ‘we’re cutting the deficit’. A government could both cut the debt and improve living standards, they do not have to be mutually exclusive. Considering the money spent on benefits for people who’re in poverty-paying jobs, surely making employers pay the living wage saves the Exchequer money and stops the public subsidising low-wage labour?

It’s clear this pervasive narrative has also been a distraction from the privatisation of the National Health Service which the coalition have successfully downplayed by referring to it as ‘reform’ or ‘reorganisation’. The Health and Social Care act of 2012 has allowed companies to bid for NHS contracts, the biggest of which in March 2013… was worth up to £780 million’. According to RT News, it ‘will see 11 private firms perform heart and joint surgery, carry out scans and provide diagnostic tests for patients from mobile medical facilities’. Among the companies engaged in bidding for contracts is Lockheed Martin, an arms producer. To add further salt to the wound, this has been carried out while cuts are taking place to public-run facilities. While there has been a lot of rhetoric from Labour on the NHS, the reality is that Private Finance Initiatives (PFI) implemented by New Labour also privatised large chunks of it under the guise of a ‘public-private partnership’. The public, perhaps quite rightly, doesn’t know who to trust. Meanwhile, across the Atlantic, the US provides us with the perfect example of an expensive, inefficient and sub-standard health system run for private profit. In the States, those who can’t afford insurance can only receive treatment if they stay in Accident and Emergency, often for days on end, their family therefore is forced to stay with them to bring them food and care for them. Our politicians continue to push us further in that direction and away from most countries in the developed world.

Despite the important issues at stake, the childish squabbles refuse to cease, so you would be forgiven by me for thinking that it’s all just theatre.