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The Privatisation of Mental Health

In the UK, 8.3 million adults are currently taking prescribed antidepressants, around 20% of the population. Since 2016 there’s been a 40% rise in antidepressant prescriptions for twenty-somethings, and 26% for adolescents. As the late, great Mark Fisher remarks: “It is not an exaggeration to say that being a teenager in late capitalist Britain is now close to being reclassified as a sickness”.

We can at least talk about the fact that people are unhappy. Witness Saqiq Khan’s 2017 campaign, where posters asking ‘Are we OK London?’ were put up in 200 tube stations.

The answer is not at all. The youth of today are thrown into such a brutal world that all we can say, along with the Cumaen Sibyl, is apothanein theloI want to die. Suicide, which claimed Fisher’s life, is the biggest killer of men under the age of 45 in the United Kingdom.

How does the culture talk about mental health today? In the words of the legendary comedian George Carlin, it tells us that You Are All Diseased. Breaking the taboo around mental health means saying that it’s normal to be unhappy, it’s normal to feel depressed, and so there is no shame in seeking help.

Let’s be absolutely clear. In today’s society being mentally unwell is normal. And people should get help.

Because the data does not lie. We are all diseased, and Sadiq Khan’s question presupposes that the answer is ‘no.’ Check up on a friend. Check up on yourself. Vast corporations - Walkers, McDonalds, Coco-Cola - are now incorporating mental health into their marketing. Fisher remarks that mental illness within our culture is now “a natural fact, like weather”.

What is going on?

Fisher thinks that what we are seeing, on a vast scale, is the privatisation of stress. Unhappiness is certainly a lucrative business. And the corporations we go to for help are precisely the ones with a vested interest in sustaining, and deepening, that unhappiness. It is estimated that this decade the value of the ‘behavioural health’ market in the USA will break the $100 billion barrier.

We are told that the cause of our illness is internal. It may be caused by a neuro-chemical imbalance. Or feelings of isolation, anxiety or worthlessness. Whatever the cause, it’s something inside us that drugs treat, or therapy locates and cures. Our mental health is thereby caught up in a cultural trend of individual ‘responsibilisation’. The shadow side of the American dream is that if success is in your own hands, then so is failure.

Hence the banishment of mental health to the therapist’s sofa; private, intimate, personal. By all means, talk about it, but this is not a conversation for the public, political space.

Which is exactly where Fisher thinks it should be. His argument is that mental illness is a social crisis; a crisis of community, a crisis of culture. “If it is true”, he asks, “that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation”.

An explanation which Oliver James’ book The Selfish Capitalist goes some way to providing. James found an intriguing pattern in society; the surge in individuals suffering from poor mental health seemed to correspond exactly with the invasion of neoliberal capitalism into all parts of public and private life. Between 1980 and 2000, rates of mental illness in the US, UK and Australia doubled.

David Smail, the late psychologist, made the same connection, independently, through his clinical work. In the 1980s, Smail saw a huge upturn in deeply unhappy, deeply distressed individuals walking through his door. They told largely the same story; accounts of intense misery invariably connected to feelings of personal failure and inadequacy.

Smail had the sudden realisation that these people were not inadequate, nor personally insufficient. In fact, they were the victims of a brutal Thatcherism that told them that society didn’t exist, and that success and happiness was simply a question of their own willing and talent.

They were the debris left behind by the wave of neoliberal capitalism, whose philosophy of hyper-individualism framed their unhappiness as the result of personal failure and weakness. Smail wrote about this in his book The Origins of Unhappiness, which argued that the growing pandemic of mental illness in society needed to be looked at, not as the isolated suffering of private individuals, but as the cultural footprint of Capital. What was required was not a voyage toward deeper insight, guided by a therapist, but a cultivating of outsight, one that saw unhappiness in its social context.

Which is precisely what the current conversation around mental health fails to do. And there’s an ideological reason for that. Fisher again: “For some time now, one of the most successful tactics of the ruling class has been responsiblisation”. If you are made to feel responsible for your own unhappiness, then it never threatens to turn its aggression outwards.

We need, now more than ever, a new conversation around mental health. We need to haul it out of the private and into the political. We need to realise that a medicalized, depressed, pathologized society is a dysfunctional one. We need to descend the ladder of personal suffering until we reach its ground in social reality.

At which moment personal unhappiness becomes political resistance. ‘Inventing new forms of political involvement, reviving institutions that have become decadent, converting privatised disaffection into politicised anger: “all of this can happen”, argues Fisher, “and when it does, who knows what is possible?”

The culture has so far succeeded in bringing to light the brutal reality of mental illness. The next step should be to illuminate its cause.

Illustration: Liza Vasilyeva

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