In its death throes, neoliberalism clings increasingly to the idea of mental illness as an explainer for the levels of rage, sadness, agitation and zombification it elicits. This is in many ways a genius move, allowing members of the establishment to present themselves as benevolent helpers whilst silencing dissent and shifting the gaze away from the root causes of the lion’s share of mental distress, which lie in adverse childhood experiences, structural inequalities and the oppressions of neoliberal ideology.
You do not need me to show you the figures. Every measure of mental ill health imaginable shows a society in freefall not only making its citizens sicker but denying them the help to get better. That is unless your stated aim is to get back to work as quickly as possible. For, soon, there will be a Department of Work & Pensions employment advisor at your therapy centre, your GP, damn it probably your local supermarket if the Tories get their way. For what worth does anyone have if not to contribute to the job market? No value whatsoever if you follow the money rather than the rhetoric to see who and what matters as a crumbling neoliberalism grips ever more tightly to its core tenets. The money trail shows us that those who fail to sustain neoliberalism’s fantasy by constantly performing work readiness – whatever the level of disability, whatever the local conditions of employment – are punished via sanctions such that claimants means to survive are quite literally removed. Similarly, if you follow the money in mental health, those who are able to return to the job market quickly are rewarded with services whilst those who have entrenched or more serious problems which privilege other outcomes are denied care.
Escalating levels of distress in the disabled population – a doubling of suicide rates in seven years, for god’s sake – are an extreme manifestation of the sick-generating policies which are causing such suffering under neoliberalism. The self has become a commodity, with simplified ideas from Cognitive Behavioural Therapies (CBT) used to inject into people the idea that they can and should be able to excise certain traits, emotions and behaviours for maximum marketability be that on their CV or via Instagram hits. This responsibilisation and the pressure to display a positive mental attitude and upward trajectory creates casualties, for not all of us can succeed as measured according to neoliberal ideals. If we do, it is bloody difficult to sustain the energy to keep it up.
Growing numbers of us collapse under this pressure, our suffering packaged back to us as mental illness rather than an understandable reaction to the environments we inhabit. Labour here needs to get radical, resisting the cross-party agreements on mental illness which foreclose the reality that though we may ‘all have mental health’ the chance of us breaking down are deeply indexed to our relative place in society and the opportunities that this affords or forecloses.
Even the most biologically minded of psychiatrists recognise that mental illness is environmental, with vulnerabilities switched on by things like adverse childhood experiences. Those on the more radical end think that mental distress is most often caused by toxic environments which get acted out in the inner world, neoliberalism being one such environment. Wherever you sit on this continuum, the evidence shows clearly that distress reduces in kinder environments. For the geeks amongst you, I point you to things like the amazing effects of reducing levels of expressed emotion (hostility, criticism and emotional over-involvement) in families, hospitals or rehab houses for those with even the most serious mental health conditions. Or an approach called Open Dialogue, which works by forming a community around someone who has just broken down to defuse panic, promote social bonds and provide a range of alternative ways of accounting for sickness from which the patient can then weave their own account. These and other forms of understanding mental breakdown and healing – from day centres to Therapeutic Communities, to relational therapies – have all lost out in terms of funding in neoliberal mental health policy to simplified forms of CBT despite their stellar evidence-base and proven cost-effectiveness. This is because the relational embodied, embedded ways of conceptualising madness within them put a finger up to the atomised individualism neoliberalism insists on.
An alternative environmental approach to understanding and treating mental ill health does not mean throwing out psychotherapy and medication as treatment approaches – far from it. However, it does necessitate widening our ideas of what it means to foster good mental health to include things like: creative, playful, less pressured early school environments for our children; a decent built environment with space for community activities; targeted interventions to prevent emotional, physical and sexual abuse and neglect; and decent welfare, social care and support for parents and families. An environmental approach also involves active campaigning to push back the neoliberal propaganda that we have all internalised, for example by celebrating the multiple ways people contribute to society, from volunteering to caring to politicking, to counter the idea our economic contribution dictates our worth. As with any social justice movement, change must be led by those who have suffered most – many of whom have developed anti-oppressive practices which combine self-care with collective action – and take an intersectional approach to understanding who gets ill and why.
In promoting new ideals which celebrate our inherent value and interdependence, it is important to acknowledge the presence of the shadow side – the envy, competitiveness, aggression and destructiveness that lie within us all. The history of progressive approaches – from political movements to radical groupings like Occupy – is one where such dynamics are denied under the veil of the illusion left-wingers are less brutal than everyone else. A gentler, more mental health friendly society is only possible if we recognise that violence and love co-exist with us all. That, if anything, should make us more committed to work together for a kinder landscape that we can then internalise such as to make life less wretched.
Jay Watts is a psychiatric survivor, activist and consultant clinical psychologist.