By Michelle La Guilla
Like poor Alice, we have tumbled into a looking glass world. As the century embarks on its difficult teenage years, as the future looks bleaker than ever before for almost everyone, a coterie of dead eyed, grinning (and crucially, rich) sociopaths literally laugh in the faces of the poor as they rob them – a familiar hobby for their leader, a man who spent his formative years cruising around in Bentleys laughing at beggars whilst burning £50 notes in front of them as a member of notorious gang of (k)nobs the Bullingdon Club. Our leaders strike me as the sort of men – and they are overwhelmingly men (overwhelmingly white male millionaires in fact, something I find so outrageous I am astonished daily people are not out in the streets going “Wait a minute!”) who enjoy pulling the wings off flies. Against this dystopian background, policies and press alike become more and more poisonous, bad and mad – one gem among multitudes came from the Daily Mail, hysterically accusing a man who was so afraid of being found fit for work he cut off his own foot and cooked it so it couldn’t be reattached, of being ‘workshy’, followed by some egregious crowing that the man in question had STILL gone on to be found fit for work. (This was cheered on by such luminously intelligent comments as ‘This shows how easy it is to get benefits’, leading one to believe the commenter had not really understood the article). Not ‘clearly desperately mentally ill’. Workshy. Such are the depths we have sunk to in our populist disgust, abjection and total lack of empathy for the poor, sick, disabled and vulnerable.
In fact, the only time the press apply the lexicon of mental illness soothingly and with concern is to the market. The market is ‘depressed’, it is ‘in crisis’, it is ‘in need of reassurance’, it is ‘crashing’. Corporations are classed as ‘people’. And actual breathing, mentally ill people are left to rot in penury and be treated as scum – increasingly, to the point of being physically attacked. In this shameful context, a new conversation – a political conversation – about mental health urgently needs to be had.
Mad and bad policy, bad and mad media, a total vertiginous reversal of what matters most – the appeasement of the equally worshipped and feared market with endless sacrifices, as if it is some vengeful, never sated pagan god, whilst enacting policies which directly affect and in one way or another impoverish, oppress, discriminate against, demonise or otherwise harm nearly all actual HUMANS – is it any wonder actual humans go mad? Or is our distress a completely natural and understandable response to a world and a polity which is becoming inexplicable, psychotic, monstrous; openly evil and obscenely, avidly greedy; beyond our comprehension if we are compassionate thinking beings? Any close examination of what is happening to millions in our country right now makes it almost self evident that mental distress is inevitable; it would be stranger if we were not depressed. And thus, any diagnosis of ‘mental illness’ and individualised treatment – usually in the form of medication – runs the risk of medicalising inequality.
This idea that mental distress is not a personal tragedy or a sign that the sufferer is defective and in need of ‘fixing’, but is conversely rooted in social conditions, form the core of the social model of mental health. In fact I would posit that the biomedical model of mental health goes further than the biomedical model of disability – mental health conditions are viewed and treated not just as a personal tragedy but a personal deficiency and bear a deep stigma. Full disclosure here – the social model literally saved my life. During my last period of depression, the worst I had suffered in years, I was suicidal. Yet I also started to get very angry. I was in the process of appealing a decision resulting from the despised Work Capability Assessments administered by French company Atos (who have since contacted me to call me in for another WCA, despite the fact that my last one is still under appeal). My partner and I were spending hours on the phone every day trying to sort out mistakes made in the administration of our benefits – mistakes in the amount, or the fact that it had never been paid at all on several occasions. The Employment Support Allowance benefit seems administered deliberately to intimidate, harass and grind down recipients, and this seemed to me confirmed when, acting on advice from Welfare Rights, I refused further ESA and my partner claimed Income Support for both of us – it came through within a week, simple as that. I felt that the world was full of horror and injustice, and it seemed very clear to me that there was nothing wrong with me, but rather that my problems were external, beyond my control and resulting from the ideological austerity programme being imposed by government. My psychiatrist asked me why I found it so scary? Yes, the cuts were unfair, he argued. But why so scared? I couldn’t articulate it then, maybe because he, a nurse and two medical students were all looking expectantly at me, but I can now – cuts, poverty, propaganda against the poor, the sick, against by extension me and others like me, environmental destruction and my own smallness and impotence in the face of all these things – who wouldn’t be frightened? I grew up in a left wing household and hated Thatcher, but was shielded from the vagaries of her policies by virtue of being a child and protected by my parents; jubilated when Labour got in but soon became disillusioned when Blair sold us all down the river; but this government’s cuts seem to me almost unprecedented in that they affect so many, almost everyone except the very rich. This time it’s personal, thought I. So instead of killing myself, I started reading about radical mental health groups and firing off emails.
But I am far from alone in my close call – so far there have been over ten thousand deaths recorded, many of them suicides, in the wake of the desperately flawed WCAs and the associated hounding by Atos. When any successful appeal against Atos’s myriad lunatic decisions (40% of claimants win their appeals, and this rises to 70% when represented by advice agencies such as welfare rights and CAB. Although you have to go to court to fight it, just so you really feel like a criminal) is followed almost immediately by another medical, and the whole sorry circus starts up again, is it any wonder people feel they will be hounded to their graves? Never mind how frightening it is for those suffering acute anxiety or even agoraphobia to go to court and fight. Couple this with a public already hostile to benefit claimants (and spurred on by the disgusting defamation in the press), and the fact that mental health conditions are invisible and thus dismissed as non existent by many (I’ve had conversations with people online where they have put quotes round the words depression, agoraphobia, anxiety; as though they are obviously fictitious ruses dreamed up to facilitate the sufferer living the life of riley at the taxpayer’s expense) and you have the conditions for a perfect storm for the nation’s mental health.
The idea that social conditions generally and capitalism specifically affect mental health adversely is not new. Marx wrote about the alienating and exploitative properties of capital a hundred and fifty years ago; the advent of factory work, he posited, and the consequent breaking up of production into many thousands of highly specialised, individual tasks, meant that wage labourers no longer had the chance to create and make products themselves, from start to finish; this alienated the worker from the product of his labours, a tragic condition for human beings, who Marx believed are both creative and social. Emile Durkheim, though occupying diametrically opposing ontological and epistemological ground, concurred insofar as believing the causes of mental distress were social, rather than rooted in individual psychology. In his famous study of suicides, all his data was drawn from statistics; Durkheim had noted that the number of suicides in any given society stayed remarkably stable over years, and only spiked during periods of great social upheaval; what he called ‘anomie’. This led him to conclude that the causes must be social in nature, and that looking into individual reasons for suicide was futile; even if it were possible to question the individuals involved, he considered, the true reasons would be unknown to them. Durkheim also wrote of the cult of the individual, words that seem prophetic in our isolated, atomised lives today. The idea that the rights, hopes and fulfilments of individuals are paramount seems a positive one, until we consider that this necessarily entails a falling away of social bonds and obligations, since under these lights – these neoliberal lights – our only obligations are to ourselves; to hell with those who fall by the wayside.
Let’s return to the market again, that sensitive flower that needs constant ‘incentives’ and ‘reassurance’ lest it fall into catastrophic depression. Back in 1944, in his extraordinarily prescient book ‘The Great Transformation’, Karl Polanyi warned of the dangers of ‘disembedding’ the market from society. He argued that historically, the market had always been embedded, and was administered via principles of redistribution and/or reciprocity. With the rise of laissez faire capitalism feted by Friedman, Hayek et al, the market became a god like entity, supported by a paradoxically stronger and more authoritarian state because the holy trinity of free market economics – privatisation, deregulation, deep slashing of social spending – caused untold human misery for all but the richest and had to be imposed by force (the examples, too numerous to list, include Chile under Pinochet, ‘structural adjustment’ programmes attached to aid for assorted third world countries in the eighties, and – less spectacular but no less valid – the whirlwind we are reaping from rabid neoliberalism under Thatcher in our own country today, which is coupled with harsh enforcement and the increasing criminalisation of dissent). This gave the lie to the familiar neoliberal diatribe about the evils of ‘planning’ – on the contrary, as we can see, such brutal policies require repression, often including ‘disappearings’ and torture to head off revolution by the poor and angry majority. Polanyi’s words about what he called ‘fictitious commodities’ similarly seem almost prophetic now. He was referring to land, labour and money, and how problematic it becomes to commodify such items – for example, if labour is a commodity, necessarily human beings are only of value economically, to be bought and sold and hired at the cheapest price that yields the greatest profits. Contemporaneously, I think we can add financial products such as hedge funds to that list – funds which essentially make high stakes bets on what will be happening in the markets. Such funds operate via smoke and mirrors, conjuring cash seemingly out of thin air, untouched and unsullied by labour which I have no doubt they see as being the province of us lower orders. A world where our leaders argue vociferously against the capping of the obscene bonuses paid to bankers who caused the crisis with their reckless, heedless gambling, funded by huge sums of essentially imaginary money, whilst capping benefits which will make the already poor – working and unemployed both – progressively poorer in real terms, is a world which perhaps unsurprisingly is rife with depression, worry and despair.
There are all sorts of dispiriting and sinister connotations which can be extrapolated when we start to think about mental health in terms of free market policies. One of the most disturbing is the controversial way ‘disorders’ are recognised in the first place. The proliferation of new labels to attach to vulnerable people is constantly growing – ADHD, the hugely contentious childhood bipolar, and personality disorder whose vague definition posits that it can be applied to anyone whose behaviour markedly and consistently differs from cultural norms. The sinister implication there is that anyone who is different, who resists, who suggests there may be something wrong with the prevailing culture or who stubbornly refuses to fit in the normalcy box, could be classified as severely mentally ill. Nor is this a new phenomenon. Let’s not forget that homosexuality, hysteria (deriving from the Latin for womb, as it was a ‘disorder’ diagnosed only in women, a tendency to fainting, irrationality, senseless rages which with a more enlightened and modern lens can be easily attributed to the mind numbing tedium of the ascribed female role in Victorian times). Similarly, ‘drapetomania’ and ‘dysaethesia Aethiopica’ – respectively, a ‘mental illness’ found only in slaves and distinguished by a single symptom, that of wanting to run away from their master (cure: heavy beating); and a ‘mental illness’ again found only in black people, which resulted in laziness and ‘rascalry’ (cure: heavy beating, again). And so going against the cultural grain at the time – considering slavery and the oppression of women morally wrong – would be grounds for the diagnosis of a personality disorder by today’s definition, showing how cultural normativity at all costs can be simply a convenient way for those abusing positions of power to silence their detractors by labelling them mad. Obviously these last four have been totally discredited, repressive notions of ‘morality’ masquerading as medical diagnoses (although the idea of the hysterical female, whilst no longer valid medically, retains a curious cultural persistence, as does the idea of the deviant, depraved homosexual), but perhaps the most risible modern ‘disorder’ is ‘Oppositional Defiant Disorder’ – main symptom, disliking authority, and perhaps particularly disagreeing with your psychiatrist. For a ‘disorder’ to be identified and listed in the Diagnostic Statistical Manual, only three psychiatrists have to agree it is a valid new diagnosis. This process of guesswork is not evidence based, and its distinctions between ‘healthy’ and ‘mentally ill’ have been criticised for being totally arbitrary. It’s also based not on knowledge of the brain but on outward signs and symptoms, which are subtle, subjective and nuanced and thus not necessarily amenable to this kind of rigid categorising and compartmentalisation. And of course, the more ‘disorders’ there are, the more new drugs can make money for the big pharmaceutical companies. If we are simply deeply unhappy, for any or all of the myriad totally understandable reasons we might be, the drug companies can’t make their millions. So they profit from our misery by pathologising and stigmatising us. It’s perhaps unsurprising that many psychiatrists have been found to have vested interests in the form of financial relationships with the big pharmas. For me personally, antidepressants and mood stabilisers have proved invaluable, and the consequences of discontinuing their use are too great – I know, because I have tried several times. However, it is morally repugnant that medication is presented as the only option, often coercively (if you refuse meds you are uncooperative and refusing to help yourself). Medication is not appropriate in all cases, and if it is not wanted, people should be supported in finding other ways to manage their distress.
And yet herein lies the rub. Mental health services are desperately underfunded, that is indisputable. However, in their present form, the potential of talking therapies to transform our mental health is limited. The approach is heavily individualised and doesn’t address the social causes of mental distress. A book I read when severely depressed advocated a ‘positive psychology’ approach of gratitude and vitality, among other things. And I understand why that could be beneficial, for some. But gratitude is hard when people have nothing – a person facing losing their home due to the upcoming ‘bedroom tax’ for example, who has to choose between heating and eating, who goes hungry to feed their children – I feel this hypothetical person, who nonetheless has thousands if not millions of real life counterparts, is entitled to feel they have very little to be grateful for. Similarly vitality – we all know it is good for our bodies and minds to exercise and eat our five a day. But gyms are the province of those on more than minimal income, and even fruit and veg are increasingly beyond the reach of the poorest due to that toxic combination of wage stagnation, capping of already inadequate benefits, and rocketing prices. The economy ranges, meanwhile, feature bleached white bread and meat so indeterminate it actually contains bits of other animals, viz the recent horsemeat scandal. Talking to each other might help more, but so many still find it hard to talk openly about mental health; and who can blame them, mired as it is in a miasma of shame and misunderstanding?
Let’s finish by taking a tour round all those affected by this government’s austerity measures; let’s illuminate why so many are unhappy, frightened, despairing. The sick and disabled are being quite literally hounded. The despised Work Capability Assessments, administered by the reviled Atos, are based on tickboxes and targets. They have been condemned by doctors. They are based on assumptions, guesses and lies. They are humiliating; they deny all dignity and humanity – for example, a depressed person can be found fit to work because they turned up clean. To prevent the loss of our income, to prevent being forced to look for work that we are not able to do and which is brutally scarce anyway, they will take their pound of flesh; we must demean ourselves by turning up filthy, stinking and babbling. The Whitehall mandarin reputed to have said, ‘If we want them to tap dance, they’ll tap dance’ may or may not have been apocryphal, but the sentiment is all too real. Atos call people in for reassessment whilst the last one is under appeal, and declare people fit for work in absentia if they haven’t returned fictitious documents that were never sent; their dirty tricks know no bounds or shame. This seemingly endless treadmill of medical, appeal, medical has understandably led many to believe there is no escape from being hounded to their graves; the death toll of this bullying, discriminatory, unjust and cruel policy is now over ten thousand; some were suicides, some died of existing conditions which were undoubtedly aggravated by the unbearable stress and worry of this horrible process. Moreover, this policy is not only utterly inhumane, it is utterly counterproductive; it is exacerbating existing mental health problems and perhaps even creating new ones in those who were previously physically sick and/or disabled; the horror and terror of the DWP and Atos’s torture has made them depressed to boot.
A nasty climate of suspicion, fear and abjection is being quite deliberately cultivated. Debts and poverty are out of control, but the payday lenders who prey on the most vulnerable cannot be regulated; they may impose interest rates of up to 4200%, but they’re also Tory Party donors. Cuts to housing and council tax benefit, including the hated ‘bedroom tax’ will eat into budgets already stripped to the bone; many will go hungry, many more will face bailiffs at the door and ultimately, homelessness. There is no longer even a pretence of support for the vulnerable, no longer any attempt to disguise the fact they are throwing the poor to the wolves whilst gleefully demonising us at every opportunity. No wonder there has been a steep rise in hate crime against the disabled. And yet David Cameron, who claimed DLA for his disabled son despite being a millionaire and the son of a millionaire, wants to take it away from millions. MPs expenses claims in general beggar belief; they can claim for their home, its furnishings, transport; their groceries allowance alone is £160 a week, and yet on their ‘basic’ income alone they could afford all these things. The people slandered as ‘skivers’ for receiving a paltry, pathetic £71 a week have to cover all of this out of that one miserable sum. Mad and bad policy in action.
The unemployed, meanwhile, must endure indignity and slur ad infinitum, despite there being so few jobs that a recent vacancy at Costa Coffee attracted 1700 applicants. Real jobs, such as they are, are also being replaced with the spiteful, quite possibly unlawful and economically nonsensical ‘workfare’ placements whereby the benefit recipient is forced to labour under threat of loss of benefit for up to three years for no more than that £71 a week JSA. Companies offering workfare, meanwhile, get a fat cash incentive just for offering the placement, and free labour; is it any wonder that they then choose to use this to replace real jobs, with the accompanying minimum pay and conditions? Thus, rich boy vindictiveness begets an even more strangled and stillborn jobs market. In our neoliberal society, paid work is god; there is no space for those who don’t fit, no acceptance that mothers, fathers, carers, volunteers, loved friends and family members have just as much value, that everyone is important. The DWP’s database Universal Jobmatch meanwhile becomes the technological arm of the surveillance state, logging a claimant’s jobseeking activities and flagging up sanctions if they are deemed not to be doing enough, never mind that the pitiful amount of vacancies could never fill 35 hours mandatory ‘jobseeking’ a week. Alec Shelbrooke, a minor Tory MP undoubtedly currying favour with the hard right, even proposed a welfare cash card so that claimants would not be trusted with money at all; such cards, he argued, would prevent benefits being spent on ‘unnecessary items’ such as cigarettes and alcohol, a charming way to stigmatise and infantilise claimants. The motion was defeated, thank God, but was ominously popular in certain predictable quarters who begrudge the poor even the tiniest of luxuries that make hard lives more bearable. Furthermore, the workfare programme has resulted in the ludicrous situation whereby voluntary work – essential, laudable, altruistic voluntary work which Cameron’s Big Society rhetoric supposedly applauds – can be used against the volunteer to find them ‘fit for work’ (never mind that with volunteering, unlike with paid work, you can choose your own hours and stop if you need to), or even more ridiculous, forcibly replaced with shelf stacking placements. Never mind that the charitable sector is already stretched to breaking point because of the cuts and relies on volunteers; never mind that volunteering has tangible benefits both for society and the volunteer, particularly for the self esteem and sense of purpose it can give to those who are unable to engage in paid work. No, we must hide and lie about the good we do if we don’t want to be packed off to Poundland. Again, who is really mad here?
What about the working poor, those diligent souls nominally feted by the Government and the media as ‘strivers’? Here we find a depressing tale of ‘zero hours’ contracts, casualisation, people trapped in stultifyingly tedious dead end jobs and still unable to make ends meet; ever longer hours, ever fewer rights; boredom, exploitation, alienation and desperation, more human beings sacrificed to the market’s bottom line. The justifications for cuts to housing and council tax benefit conveniently obfuscate the fact that these benefits also support a population in work, those downtrodden rather than uplifted by its supposedly magical properties; working all the hours god sends, passing children and partners like ships in the night, but still not making enough to survive. The cuts to housing benefit may well lead to a rise in homelessness among workers; Barbara Ehrenreich documents just such a chilling phenomenon in her excellent book ‘Nickel and Dimed’, an ethnography of working poverty in America; with no equivalent of housing benefit, and unregulated, rocketing rents, she describes how many of her co-workers had no secure accommodation, and slept in their vehicles or homeless hostels.
The cuts are also disastrous for women; it is proven that benefit cuts will hit women hardest, as we shoulder most of the caring responsibilities and make up most of the underprotected part time workforce. Women’s refuges are shutting almost daily, even as the incidence of domestic violence shoots up, in response no doubt to poverty and frustration. Changes to legal aid and benefits mean abused women and children will be unable to afford to escape, or to prosecute their abusers. Some commentators have stated, and I concur, that the cuts amount to state sponsored discrimination against half the population. The mooted repeal of the Human Rights Act also has terrifying connotations, protecting as it does our freedom of assembly (so bye bye trade unions), our right to privacy (so the government can read our personal texts and emails), our right to a fair trial (hello secret courts, where the defendant is not allowed to even hear the evidence against them); its repeal would also remove the government’s responsibility to refrain from unlawful killing, investigate suspicious deaths, and prevent foreseeable loss of life. This is clearly a responsibility the government has spurned for a long time now with regards to its treatment of disabled people (let’s remember again: ten thousand dead and counting), but repealing this act would give them carte blanche to commit wholesale murder, whether by omission or commission. Additionally, its edict against forced labour is politically inconvenient for the government’s workfare policy.
As students, we are not immune to this phenomenon either. An average undergraduate degree now costs in the region of £26 000 and rents for shoddy, damp, often unsafe student houses are rocketing; our education is increasingly run along neoliberal lines, meaning research modules are cut and business and management degrees proliferate. The old idea of university as a time to enjoy learning for its own sake is dead and gone; now we are exhorted to run for office, to not just join societies but hold positions of responsibility within them, to work in our holidays, to make every spare moment productive, all in the service of that magical and elusive quality, ‘employability’. This high pressure, uncertain environment can be deeply deleterious to mental health; as can the worry that no matter how many bells and whistles festoon our CVs, there may well be no job for us at the end of all our hard work. In our turn, we may well be demonised as feckless and workshy for being unable to find employment. We are reaping the whirlwind of a market gone mad, and the harvest is bitter indeed.
At Lancaster, there have been some notable successes in mental health provision for students. A long term campaign to improve the counselling service both in terms of availability and context of sessions (some sessions were being held in open spaces where people could see in) has resulted so far in 25 more sessions a week being added, with a report on longer term solutions by the Head of Student Wellbeing promised. And this year, a new student run group, LU Open Eyes, Open Mind, has started up. Becky Sophie, the founder and president, told me: “I started Open Eyes, Open Mind because of the strife of a member of my family. I watched as they struggled through university thinking that it was sad but not truly understanding the terrific strain of mental illness. I then developed depression and felt the full force of the stigma of GP’s, peers and most painfully friends. It is a necessary cause because the stigmatisation of mental illness at university is shocking and universities appear to do little to educate the student body on the immorality of this. I fully support the counselling services but whilst their funding is cut, fewer voices are being heard and the people whose voices these are are in real danger of being left by the wayside. I just want there to be a method of communication both to teach and to learn and to hopefully watch others do so.”
This development, as a sufferer of chronic depression and anxiety myself, fills me with hope. On early showings there is great enthusiasm for Open Eyes, Open Mind and a feeling that this is something that’s needed. But I believe we need to go even further. We need to stop medicalising inequality. We need to refute the idea that mental illness is some kind of personal defect, something in us that needs to be fixed. We need to say, there is nothing wrong with us, that what is so glaringly wrong is outside of us, deeply embedded in the vagaries and cruelties of modern industrial capitalism, a wounded beast more dangerous than ever in its desperate death throes. We need to say, is it any wonder we are mad, when our incomes, our prospects, our very souls are being attacked from all sides; when to dissent risks incurring police brutality or at the very least a criminal record; when our characters are assassinated in the media daily?
Depressives, agoraphobics, schizophrenics of the world unite! We have nothing to lose but our demons!