Sunday, April 30, 2017

Marxism, Psychiatry, and Capitalism

Marxism, Psychiatry, and Capitalism

This is the transcript of a recent email interview I did with Dr. Bruce M. Z. Cohen, senior lecturer at the University of Auckland and author of Psychiatric Hegemony: A Marxist Theory of Mental Illness (Palgrave Macmillan, 2016), where we discuss capitalism, psychiatry, and view psychiatry under a Marxist lens.

1. What made you want to apply a specifically Marxist view to psychiatry and psychology?​ Are you personally a Marxist and how did you come to be one?

That’s a good question. I didn’t expect to ever be writing such a book, but thanks to my students I realised that someone had to take responsibility for filling a current gap in the literature. I run a postgraduate course on the Sociology of Mental Health, in which my students complete project essays on topics of their own choosing. As it is a sociology course, they are obviously required to apply different theoretical approaches to their chosen issue. I always encourage the students to consider the wide range of theoretical approaches available to them including structural functionalism, labeling, social constructionism, Foucauldian, critical feminist and race theory, as well as Marxist scholarship. Regarding the later, my students complained that they couldn’t find anything much out there. As a lecturer, I am always a little skeptical of such claims, but –hats off to my students!– they were correct on this occasion. With all the literature on mental health and illness currently in circulation, I found it astounding that there was no standard Marxist account available. Hence, the main reason for writing Psychiatric Hegemony: A Marxist Theory of Mental Illness.

To answer the second part of your question, yes I am a Marxist! Though I grew up in a very conservative –large as well as small ‘c’– part of England in the 1980s, my parents were members of the CPGB (Communist Party of Great Britain). (In fact, my mother became the first communist parish councilor in the area, kicking out a Tory in the process). So I was politically conscious and politically active from a young age thanks to my family, imbued with a strong sense of social justice, and particularly incensed by Thatcher’s attacks on the trade unions and the working classes at the time (which most people in my area thought was just fantastic!). But I think being a sociologist has really made me a fully committed Marxist; whichever area you are studying or working in, be it religion, education, health, crime, the family, or whatever, it doesn’t take long to uncover evidence that the needs of capital determine the priorities of these institutions– they reproduce inequalities, oppress the majority of the population, and produce surplus value for a privileged minority. Is this a kind of society that, in good conscience, I or any sociologist can accept or support? Of course not! That’s why I’m a Marxist. Human beings can do better.   

2. Discuss the connection between psychiatry, psychology, education, and capitalism and how the former institutions have been influenced by the latter, historically speaking.

Following my point above, the mental health system (I use this as an umbrella term here to bring together psychiatry, psychology, and the various support professions and agencies working in the area of mental health including therapists, counselors, psychiatric nurses, and social workers) and the education system in their contemporary forms are both products of industrial capitalism. Briefly, compulsory schooling developed across western societies in the nineteenth century due to the needs of capital for higher skilled workers as well as to socially control working class youth (through, for example, socializing them into the norms and values of capitalism as the only “correct” way to think and understand the world). As I discuss in my book, the mental health system develops during the same period as another institution of social control: the asylums separate the able from the non-able bodied, it pathologises and confines problematic populations (primarily working class groups).

In neoliberal society, I argue that the connections between the mental health system and the education system (as well as many other areas of public and private life) have become much stronger and more explicit. For example, my socio-historical case study of attention-deficit/hyperactivity disorder (ADHD) in the book demonstrates that the origins of the diagnosis began with psychologists’ concern for deviant working class youth who failed to “adapt” to the demands of compulsory schooling. A hundred years later, we can still see in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that the symptoms of ADHD have nothing to do with having a mental illness but rather denote the requirements for more productive and efficient students and workers (for instance, forgetting or losing homework, failing to complete assigned tasks, poor time-management, and so on). As the demands on young people to stay on at school and go further in education have increased, so we have seen an increase in mental health experts in this area, and thus the increasing medicalization of “at risk” (I would argue, non-conforming) children. The expansion in the use of diagnoses such as autism and “oppositional defiant disorder” by psychiatry can also be theorized as serving a similar purpose here.

3. In what way does capitalism utilize psychiatry and psychology to demonize and ridicule those who have politics that don't fit with the status quo? (This has been talked about somewhat before and I would be interested in hearing you expand upon it.)

I devote a chapter to this issue in my book, but to be honest I think a whole monograph is required on the subject. It’s a fascinating (and, as you do the research, shocking) issue. I can follow many other scholars by reiterating that the mental health system is highly effective in neutralizing threats through pathologising political and social dissent. I think it’s more effective than say the criminal justice system because the courts are usually questioning the legality of the person’s actions alone, rather than the rationality or sanity on those actions. Imprisonment of a protester, for instance, does not fundamentally undermine his or her actions or beliefs in the same way as being labeled as mentally sick does.

There are many examples of this process in operation. In the late nineteenth century, the suffragette movement was a frequent target for the “hysteria” label. During the civil rights movement in the US, there was a significant increase in the labeling of young Black men with “schizophrenia” (psychiatrists sometimes referred to this as “the protest psychosis”). Similarly, young African-Caribbean protesters in the deprived inner cities of 1980s Britain were theorized by psychiatrists as prone to “cannabis psychosis.” As I mention in the book, I think an increasingly popular diagnosis which the mental health system is utilizing to pathologize those involved in civil disobedience or political violence today is antisocial personality disorder (APD): post-9/11, you can see that psychiatry is taking a much greater interest in medicalising any behavior which breaks the legal or moral status quo within capitalist society, particularly acts which involve perceived or actual violence.

4. How is psychiatry not an actual science in some ways? May people assume it is just by virtue of its utilization of ‘experts’ and ‘quantitative studies’?
This is really at the heart of the matter. To be considered as a valid branch of medicine, psychiatry has to reach the medical “gold standard,” which is to observe and identify real pathology on the body. And, though they’re tried repeatedly to do this, so far psychiatry has failed in this fundamental goal. Most recently, for example, the American Psychiatric Association’s (APA) DSM committee (which was responsible for producing the DSM-5) came to the following conclusion: the causation of mental disease remains unknown (for example, there is no useful biological marker or genetic test that has been identified) and psychiatrists still cannot distinguish between mentally healthy and mentally sick people. And of course without accurate identification of disease, a medical discipline cannot claim proof of causation or evidence of successful treatment, and they certainly cannot predict future cases of that disease.

So, to answer your question, no psychiatry is not a valid medical science. However, I argue in the book that progressing knowledge on madness (if such a thing is even possible) was not the reason for the establishment of the psychiatric profession or the continuation and expansion of the mental health system today. Rather, it’s a discipline that has supported capitalism, both in the pursuit of surplus value as well as being an institution of ideological control, responsible for reinforcing the norms and values of this society and punishing deviations from them.

5. In what ways does this massive increase in the labeling of people having psychological disorders affect us on a personal, familial, and community level? How does this increase the alienation from ourselves and our larger communities that has been going on for some time now?

The biggest issue is that it individualizes what are fundamentally social and political issues in this society. This obviously suits capitalism, it follows a neoliberal ideology that you need to work on yourself and look nowhere else for solutions to your problems. As I argue in the book, this is why the psychiatric discourse has been allowed to become all-encompassing (effectively “hegemonic”) over the last few decades; it has become highly useful in de-politicizing the oppressive reality of our lives. The involvement of the mental health system here is only one factor in the bigger issue though, which is of course the way the neoliberal project has attempted to destroy the social and the collective.

6. What are the negative aspects of self-diagnosing and how does that reinforce the status quo?

As with Marx’s famous comments on religion as the opium of the people, I think we can understand self-labeling and people desiring to have such a label as a way of coping with the alienating tendencies of capitalism. It’s no solution to the fundamental issues they have, but it can be a means of survival and maybe a limited form of “emancipation” at times. For example, the parents of a child who is underperforming in school may desire a mental illness diagnosis so that they can claim extra funding for study assistance, or someone who doesn’t enjoy socializing in large groups may seek a psychiatric diagnosis so that they can legitimately take antidepressants which dull their inhibitions.

There are a number of significant problems with self-labeling: most obviously, you cannot solve the social and political problems of capitalism with a mental illness label or by being subjected to talk therapy, drugs, or electroconvulsive therapy (ECT). It can obviously be dangerous to your health (for example, long-term users of antidepressants tend to die at a considerably younger age than non-users), and it can be stigmatizing. Further, it falsely legitimates the mental health system as a valid medical enterprise.

7. How do you see the working class overcoming this system?

Ultimately it’s a case of abolishing the mental health system and all its supporting apparatus. As with the criminal justice system, this is not an institution that has ever functioned in the interests of the working classes. At the end of my book I suggest a few practical things that can be done immediately to challenge and weaken the power of the mental health experts, these include: campaigning to remove psychiatry’s compulsory powers to confine and drug people against their will, withdrawing their prescription rights, and outlawing ECT.  I also think it is crucial to form closer alliances between academics, left wing activists, community groups, and progressive psychiatric survivor organizations to build a strong abolitionist alliance against the psychiatric system.

8. Tell us about your upcoming book and where you and others argue that “the best form of treatment for mental disorder is no treatment at all, and the causation of mental illness itself has yet to be established.” It would be great to hear about those last two parts in-depth.

Well, I’ve hopefully addressed those two specific issues previously in this interview – what passes for “treatment” at the hands of the mental health system is, ironically, very bad for your physical and emotional health. Perhaps that is unsurprising given that mental disorders are fabrications produced by psychiatry without real evidence for their existence.

The Routledge International Handbook of Critical Mental Health (due out later this year) is an edited collection of original contributions from colleagues in the US, Europe, Australia, New Zealand, and Canada, which systematically problematizes the practices, priorities, and knowledge base of the western system of mental health. Basically, I have constructed a comprehensive resource manual which offers a variety of ways in which to theorize the business of mental health as a social, economic, political, and cultural project. So, for instance, the book provides updates on critical theories of mental health such as labeling, social constructionism, antipsychiatry, Foucauldian, Marxist, critical feminist, race and queer theory, critical realism, critical cultural theory, and mad studies. But it also demonstrates the application of such theoretical ideas and scholarship to key topics such as medicalization and pharmaceuticalisation, the DSM, global psychiatry, critical histories of mental health, and talk therapy. I’m very pleased at how it has turned out.

9. Is there a way to bring back a form of alternative psychiatry or psychology at all?

Some scholars are positive about the development of a post-revolutionary “Marxist psychology” or similar. I don’t think that’s possible, and I worry about giving these professions any sort of way out. My analysis points to these professions as agents of social control; they have always been responsible for policing the population not for emancipating them. So my answer to that question is an emphatic “no!"

Bruce M.Z. Cohen is a Senior Lecturer in Sociology at the University of Auckland, New Zealand. His other books include Mental Health User Narratives: New Perspectives on Illness and Recovery (Palgrave Macmillan, 2008) and Being Cultural (Pearson, 2012).

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