Saturday, 25 October 2014

Mind control or social control

Compassion for those suffering mental health problems is a “great liberal cause” said UK deputy Prime Minister and Liberal Democrat leader, Nick Clegg, earlier this month. Promising to end the stigma around mental distress, Clegg said he wanted Britain “to be a country where a young dad chatting at school gates will feel as comfortable discussing anxiety, stress, depression, as the mum who is explaining she sprained her ankle.”

We have here all the ingredients for the classic British political debate. In one corner the liberals or centre-left want equality and compassion for people with mental health problems (former Labour spin doctor Alistair Campbell advocates parity of understanding and services between physical and mental health) while, in the opposite corner, conservatives favour forced treatment and a more punitive approach. Let battle commence.

It is, of course, a phoney battle. What is conspicuously missing from the debate is a sense of curiosity as to why “anxiety, stress, depression” are so widespread. To do so, would diverge from the neo-liberal obsession with wiping away the consequences, and enter into the no go area of root causes.

But what is most revealing is what kind of treatment the mentally distressed would receive should it actually be there.  According to Clegg three-quarters of patients, those who are anxious or depressed, need access to “talking therapies”. This invariably means some form of ‘cognitive behavioural therapy’ (CBT) which can take place one-to-one or in a room with 300 others. CBT is now the NHS’s mental health treatment of choice (aside that is from prescribing anti-depressants).

Self-administered mind control

CBT tries to get the patient to change their attitude to the world around them, and in the process, come to understand that the complexities and frustrations it generates are, in fact, produced by themselves, not by other people or the world outside. According to the psychologist, Oliver James, CBT makes the assumption that “unpleasant emotions result from inaccurate thinking”. CBT can be beneficial, says James, because having a sympathetic but independent shoulder to cry on, is helpful in itself. But its effects are often ephemeral and, he believes, it “explicitly discourages patients from considering the childhood origins of their problems, and even worse, [it] actively rejects any analysis of how the person’s society could be making them ill.”

CBT, this society’s response to the epidemic of mental distress, is actually a microcosmic version of its belief about how a healthy person should live their life. Happiness, or its lack, is the personal responsibility of the individual, and can be attained with the right attitude. The outside world is taken as an unchangeable given. If the conventional route of career advancement doesn’t work, or doesn’t supply enough meaning, there are legions of self-help or positive thinking regimens to fill the void. If that doesn’t satisfy, versions of Eastern religion and Buddhism are on hand to provide ancient wisdom. But what all these different disciplines have in common is an unshakeable focus on a person’s internal life, not the world ‘out there’. We are, says the writer Dan Hind, offered various regimes of “self-administered mind control”.

And when the world doesn’t respond as it should, there is no-one to point the finger at but ourselves. The sociologist Richard Sennett has made the disconcerting discovery that in recent years, people who are made unemployed for structural reasons, nevertheless blame themselves for their joblessness. The UK government seeks to change attitudes among unemployed benefit claimants as if that is all that is holding them back. But a go-getting attitude will not make falling real wages rise, turn last-ditch self-employment into an entrepreneurial road to riches, or transform workers into anything other than “labour costs” for those eager to exploit them. Social problems will not be solved by individual solutions.  Moreover, the incessant focus on ourselves has not reduced depression or anxiety. Rather they seem to become more prevalent with each passing year.

Step outside

Perhaps we need to turn the telescope around.

Admittedly this seems counter-intuitive. “An alternative perspective, one that takes into account the social and institutional circumstances of life and seeks to reform their pernicious effects on the self, seems somehow confused,” says Dan Hind in his book, The Return of the Public. “How can I help myself if I don’t concentrate all my energies on myself?”

But in actual fact, turning away from ourselves and instead concentrating on changing the external world may be the route to better mental health. The Second World War in Britain was a time when the country definitively turned away from private concerns to face an external enemy. Yet, contrary to the predictions of psychiatrists, mental distress declined during the war. Physical health also improved and perhaps even more counter-intuitively, life expectancy in Britain during World War 2, rose.

We know that gross inequality feeds mental distress, and that a consumer society that constantly presents images of others enjoying the blessings of a materially superior life, are lethal to feeling  good about yourself, yet vital to a capitalist economy that lives on the profits of selling more and more products. A serious endeavour to “de-marketise” our society, to provide a basic and secure income for all, to return public services to a concern with the experience of the user, not the profit of the investor, to supply the basic necessity of affordable, decent housing, and above all to reduce the sense of being ripped off and exploited at every turn, would, I am sure, result in a quantifiably mentally healthier society. Certainly, a less anxious one.

One of the blights of our time is loneliness, a state which can easily lead to anxiety or depression. Dan Hind, whose chapter in The Return of the Public, entitled ‘Estranged from Ourselves’ is well worth reading, advocates the formation of assemblies in each Parliamentary constituency to debate issues of public concern. Freedom, he says, “requires the opposite of solitude”, and a place to meet other people in conditions of equality, not seeing them as economic rivals or clients, may be the opportunity to turn away from ourselves that we most need. “There are few of us who wouldn’t benefit from some time spent talking in confidence with a qualified professional,” he says. “But all of us would benefit from talking with one another about matters of common concern.”


  1. Good post. I've increasingly come to think that a new politics needs to be formed almost in opposition to the self-help industry, which advocates only that you change yourself, and is mostly even more poorly evidenced than CBT. But to do this we have to imagine a restructuring of the world that isn't utopian or even far in the future. Because it's no good saying that your anxiety etc will be resolved in 50 or 100 years time. We have to be able to restructure our world through struggles in the present day. In other words the process of political struggle itself has to at least begin to resolve some of these problems. Which means we need to think about the form that political groups and campaigns take and how they can become processes of mutual support *whilst* promoting or developing X political end or idea.

  2. Excellent, thought-provoking post. It occurs to me that it provides a powerful argument in support of the ever more compelling idea of a Universal Basic Income - soon to be the subject of a Swiss referendum. A key argument for this is that it would liberate people from the insecurity and anxiety associated with needing to have a job just to survive - in a world where conventional full-time employment is an increasingly elusive dream for many if not most because of technological change - not to mention the social stigma of being dependent on state benefits.

    Pursuing this thought further, one realises that the major reason the elite resist any notion such as UBI is that it would free people from the controlling power of the authorities (cf. Marx's concept of wage slavery). Rationally you might think they would welcome the possibility it might bring of cutting the social / NHS costs of dealing with mental illness, not to mention crime. But of course in our privatised economy health care and criminal justice are now viewed as market opportunities by the corporate sector (psychiatrists, Big Pharma, security firms) - at least until the taxpayer runs out of money.