Why does British society generate so much mental illness?

If a list were to be made of the recent British government policies responsible for inflicting the greatest suffering on the domestic population, the Work Capability Assessment (WCA) would surely emerge as undisputed table-topper. The tick-box test, introduced by the last Labour government in 2008, to determine whether people are ‘fit for work’ and thus eligible for benefit or not, has spread an atmosphere of dread among the sick and disabled people subjected to it.

The WCA has generated a morbid parade of destroyed lives and the disappearance of hundreds of  thousands of people, estimated to be 30% of those found’ fit for work’, into the netherworld of not working, or claiming any benefits. Destitution, in plain language.

One group, though, have proved particularly vulnerable – those with mental health problems. Around half of those subject to a WCA have a mental health condition. Last month, researchers linked the WCA, or simply the threat of it, to 590 suicides and more than 700,000 anti-depressant prescriptions. Psychiatrists have blamed the test for causing relapses in patients with severe mental health problems. Even ‘passing’ a WCA and being declared ‘unfit for work’ doesn’t stop people being hounded. There has been 668% rise in the last three years in Employment and Support Allowance claimants (i.e. those considered too ill to work) with a mental health condition being sanctioned.

But quietly unnoticed is that the WCA is not working even under its own brutal terms. The test was an example of ‘austerity, before austerity’. In the 2006 green paper on welfare reform, then work and pensions secretary, John Hutton, promised the WCA would save taxpayers up to £7 billion a year. Despite seven years of culling and sanctioning, this hasn’t materialised. The Office of Budget Responsibility estimates that spending on incapacity benefits will rise from £13.4 billion in 2013/14 to £14.5 billion in 2018/19. Overall, ‘welfare’ spending is also set to increase, says the OBR.

Mental illness epidemic

But amid a benefits systems that seems to be doing its level best to make mental health problems worse rather than better, we need to ask a simple, though easily overlooked question – why is this society, British society, generating so much mental illness in the first place?

Because as fast as the DWP can declare people fit for work or sanction them, new claims are made. According to the OECD, 40% of new disability benefit claims in Britain are because of mental health problems, the highest proportion among all 34 member countries. The latest figures indicate that 48% of Employment and Support Allowance claims are for ‘behavioural and mental disorders’.

It is a question our political rulers are oblivious to. The Conservatives respond to the mental illness epidemic by mooting forced treatment. The opposition parties espouse a more compassionate approach but settle on superficial ‘talking cures’ such as cognitive behavioural therapy. And they still cling to the Work Capability Assessment*, which has caused so much suffering and distress. In the case of the Liberal Democrats and non-Corbyn Labour, they also still cling to austerity.

Austerity and social security cuts are a production line for the very mental health problems the political class claims it wants to reduce. The Centre for Welfare Reform has blamed policies such as the bedroom tax for ‘savaging’ people’s mental health. The group ‘Psychologists Against Austerity’ has identified ‘austerity ailments’, such as humiliation, insecurity and powerlessness; all experiences that “lead to mental distress”.

Even the staid OECD have concluded you have to look deeper in order to stem the torrent of mental illness. According to the OECD’s Shruti Singh, ‘job strain’, bad line managers and long hours’ are all “detrimental to workers’ mental health”.

But far from being alleviated, ‘job strain’ is being intensified. In 2014, researchers from Cambridge University found zero hour contracts were just the ‘tip of the iceberg’ of flexible employment practices causing widespread anxiety, stress and ‘depressed mental states’.

Extreme part-time contracts, where workers must work overtime to survive, ‘flexi-contracts’ which don’t provide sufficient hours to make a living, and key-time contracts where employees are given limited core hours and forced to state additional hours they can work, are inflicting suffering on ‘huge numbers’ of workers, researchers from the university’s department of sociology said.

These are “all experienced as a form of job insecurity that causes untold stress for thousands of employees and their families,” they concluded.

Evidence is conclusive that job insecurity and lack of job control is lethal to both physical and mental health. Research featured in the 2009 book The Spirit Level that tracked Whitehall civil servants of varying grades demonstrated how low job status was related to heart disease, cancer, gastrointestinal disease as well as depression, suicide and sickness absence from work.

Mental distress is socially caused

It is here that a deliberate blindness on the part of ruling elites needs to be exploited. As the writer Mark Fisher has argued, the dominant way of thinking simply cannot concede the social causation of mental illness. Debate is strictly limited to a fight between ‘hawks’ who want to crack down on the financial burden of the psychologically distressed claiming state benefits and ‘doves’ who wish to reduce stigma and increase access to alleged therapies such as CBT. The extreme prevalence of mental illness is assumed to be an unfortunate accident of individual brain chemistry and genetics.

But curiosity in this regard can be subversive. We need to vastly expand our horizon of what engenders mental health and the factors that lead to its opposite. A genuine attempt to reduce mental health problems needs to start by fundamentally de-stressing the workplace, enhancing the condition and stability of housing and removing the ever-present dread of income being snatched away.

This is just a start. Successfully combating mental ill-health is dependent on creating a less unequal, more socially just and less stressful society. Radical political changes such as worker self-directed enterprises, a basic income and a huge expansion of social housing, need to come to the fore. Coincidentally, these are precisely the political directions we should be going in anyway.

In the 1950s, the famous German psychoanalyst, Erich Fromm, advocated concentrating our energies on creating a ‘sane society’. It is an aspiration that needs reviving.

*The Work Capability Assessment is a classic example of the extremism of the political centre. The WCA was created by the Labour party in 2008, and, in fact, the proportion of people left destitute after being found ‘fit for work’ following an assessment was higher under Labour - 55% - than under the subsequent Conservative/Lib Dem coalition, when it was estimated to stand at 30%. The Conservatives, upon assuming power in 2010, embraced the WCA with gusto and extended it to existing Incapacity Benefit claimants. Under Labour it was had merely been used on new claimants but had Labour won the 2010 election, they, too, would have extended it in the same fashion. The Liberal Democrats, as dutiful coalition partners, supported the WCA.

These actions were all undertaken by political parties scrambling to be regarded as centrist. Labour, under Blair and Brown, coveted the fabled ‘centre ground’ of politics. George Osborne claimed in October that the Conservatives had created a ‘new centre ground’. The Lib Dems, have always presented themselves as neither Left nor Right, but centrist.

Still, none of the main political parties have come out against the WCA. The Conservatives swear by it, the Lib Dems promised a review at this year’s general election, and Labour, under Corbyn, has so far only committed itself to a ‘complete overhaul’, not abolition. Likewise the SNP went into the last election pledging an overhaul of the WCA. Although a working group established by the Scottish government did recommend the WCA be scrapped in an independent Scotland.

The only parties firmly committed to abolishing the WCA are outside the mainstream – the Greens, and even UKIP, yes them, amazingly enough.

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.”