One topic that’s been particularly interesting to me since I started studying critical theory is the mental health system we have in the US, meaning methods of diagnosis and treatment for mental illness, products like medications or mood tracking apps, and the institutions and industries that provide these things.
As a survivor of years of ineffective psychiatric treatments, this topic is unavoidably personal. When I was diagnosed with bipolar disorder at 16 I thought my fate was sealed, that I was too unstable to ever function normally in society. I was told it was a lifelong illness and I’d have to stay on toxic, life-threatening medications forever. I started taking lithium, and then an antipsychotic, and the list kept growing after that. Abilify, Adderall, Ativan, so on and so forth. I believed bipolar disorder was the primary fact of my identity—something I’d always have to live through and negotiate with. I thought I’d always have to rely on doctors to explain what was wrong with me, and pharmacists to refill my necessary prescriptions every month, lest I descend further into insanity. I was told 20% people with my condition would commit suicide, and I really believed I’d spend my life struggling with that possibility.
Seven years later, I don’t take any medications, nor do I even believe I’m mentally ill. This might sound like “treatment non-compliance,” but I think this critical refusal was actually the best treatment I ever got. I feel more stable, healthy, and empathetic towards others than I ever did on the meds. I haven’t been suicidal, or anything close to it (I can’t say the same for when I was still on the meds). In fact, I’m usually happy. Most shockingly, I have a much higher capacity for focusing my attention, and a much higher tolerance for difficult emotions, than when I was taking drugs that were supposed to improve those things.
Maybe I was misdiagnosed as a teenager. That’s what a psychiatrist would say. But couldn’t it also be the case that we don’t fully understand bipolar disorder? After all, we have yet to discover the underlying pathology of any mental illness. We just have statistical correlations, best guesses based on cultural biases, and small-scale, short term clinical studies run by drug manufacturers. (I’m not exaggerating; Robert Whitaker’s Anatomy of an Epidemic provides evidence for all the claims I just made).
While my recovery based in anti-psychiatry and critical theory is just personal testimony, it highlights how neoliberal subjectivity traps us in a neoliberal worldview, where people are human capital constantly maneuvering in market situations, and anyone who can’t keep up has something wrong with them. In order to successfully come off of all my medications I had to change my perspective entirely—I had to stop believing in the metaphysical authority of pharmaceutical treatments and develop an image of myself as something other than a broken person or a bad worker. That took the courage, and privilege, to stay home for months of withdrawal, reading books to gain a different perspective on my “condition.” I think it’s quite likely that many other people are facing the same situation today that I did seven years ago. What worries me is that the majority of us don’t have the resources I did to escape the system and find happiness.
As a nation, we have a serious mental health epidemic— rates of diagnosis are increasing, especially among younger people. These are people who have grown up with smartphones, social media, and constant audits and surveillance, into a world of financial crises, austerity, and debt. They are through-and-through neoliberal subjects and I don’t think it’s just a coincidence that their mental health is so poor. This isn’t even an uncommon theory. The Time magazine I recently found at a grocery store was a special edition on ‘The Age of Anxiety,’ and among possible causes of mental distress it listed economic and political circumstances, social media and phone use, and increasing pressure on kids in school. It’s not a secret that there are societal—not internal—sources of stress, anxiety, depression, and other mental ailments. But they aren’t listed in the diagnostic criteria. There is no “economic recession syndrome” or “political instability disorder”—mental health diagnoses frame mental illness as a personal, individual issue. These diagnoses are centered on the poor functioning of the individual, not problems of social/economic/political organization.
So, the question for critical theory isn’t simply, “Does neoliberalism cause mental illness?” I think the evidence is there that aspects of our society cause us distress, but also since there’s no conclusive pathology of mental illness, my claim would be as difficult to prove as the persistent myth that neurochemical imbalances cause mental illness.
Instead, I’m interested in how the mental health system might reinforce, or even help produce, neoliberal subjectivity. We should examine the relationship between neoliberalism and the mental health system, both historically and in terms of logics, tactics, and practices. We should also look at popular discourse around mental health, on social media or in major news publications. I want to understand to what extent our mental health system is tied up with the neoliberal episteme, and whether it’s serving the interests of the market over its patients. Is the system working, or is it causing us more problems than it solves? Do we address the mental illness epidemic by expanding diagnosis or reducing it? Protect mental health services against budget cuts or do away with the system in favor of something new? This leads me to a final, speculative question: what does a mentally healthy society look like? What is actually effective mental health care, and how would we evaluate its effectiveness? Is “mental health” even the right thing to be pursuing?
These questions are part of a larger ongoing project, so there’s a lot left to be answered. These are just some initial thoughts. In line with historian Philip Mirowski, I’ve come to see neoliberalism as, overall, a philosophical or epistemological project. It presents a certain comprehensive picture of reality that seems to be objective, but artificially limits what we can imagine and what we believe is possible. This is what Mark Fisher identifies as capitalist realism. Neoliberal subjectivity is one part of this larger epistemological picture. It shapes the available options for how we understand ourselves and our places in society, and I see the mental health system as an important site where this happens.
Firstly, a lot of treatment methods are based in (purportedly) scientific methods and quantification. They’re purportedly objective and value neutral, but as William Davies argues in The Limits of Neoliberalism, this is really a way of disguising a priori value judgments, in fact keeping them from even entering the conversation. No empirical tool can empirically justify itself. The real authority of metric-based methods like mood tracking apps comes from our cultural faith in science and technology. Just as we trust models in the physical sciences to describe how the world works, we trust algorithms in these apps to tell us if our mood has improved. A similar phenomenon takes place with questionnaires used to determine if someone is clinically depressed. It doesn’t matter if you consider yourself depressed, your quantified score will tell you if you’re past the threshold or not. In these situations, the objective metrics designed by scientific experts have more authority than an individual’s subjective feeling.
As a consequence of the elevation of scientific metrics over subjective experience, the modern diagnostic criteria for mental illness fit very nicely with the hollowed-out, neoliberal image of the individual. The individual in neoliberal philosophy is human capital and data-fied behavior. Human capital is the quantified representation of their skills, abilities, and even mindset/feelings, basically their usefulness and value to the market. Behavior—choices, market transactions, and everything the individual does and says—can be turned into data used either to predict the individual’s behavior in the future, or the average behaviour of aggregate groups of people. The neoliberal individual’s moral convictions and interiority don’t matter, only external measurable things. They’re reduced to a behaviorist/physicalist machine, a “black box” with inputs and outputs, consuming and producing.
The productive aspect here is key. Today, the goal of ‘recovery’ from mental illness is work capability. A mentally ill person needs to get better so they can return to work, so they can be useful for society rather than a burden. This becomes especially visible when austerity cuts reduce the role of the state in providing care, expanding the responsibility assumed by the individual (either to practice self-care or consume private care). In Family Values: Between Neoliberalism and the New Social Conservatism, Melinda Cooper shows how welfare cuts increase private responsibility. The less the state provides, the more the individual must provide through private sources. That is, of course, if they can afford it. If their mental illness is severe enough that they can’t work, they may wind up unemployed, on the welfare system, jumping through hoops to prove themselves. Dr. Ruth Cain, a legal scholar in the UK, sees the imperative towards returning to work as a disciplinary method, reinforcing neoliberal personal responsibility. Individuals are forced to present a smiling face and demonstrate constant improvement and a desire to return to work as soon as possible, or else they’re seen as undeserving of state support.
These are just a few examples of neoliberal logic, tactics, and practices in mental health care. But that’s just in the US and the UK, already thoroughly neoliberalized nations. I should also address the global, international implications of neoliberal mental health care. In the book Crazy Like Us: The Globalization of the American Psyche, Ethan Watters describes the disastrous effects of introducing American diagnostic criteria and treatments in other nations and cultures. Each culture has a “symptom pool” of socially understood pathological behaviors, which consciously or unconsciously affects patients’ expressions of illness. Western psychiatrists and the DSM are attempting to standardize those symptom pools, but with a particularly American and Western cultural slant, which can do more harm than good.
Watters writes, “Western mental health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory, and a source of moral authority. None of this is universal.” The introduction of Western mental health discourse, backed by the metaphysical authority of science, invalidates all other explanations of subjectivity, mental illness, and what it means to be healthy. There is a sense in which Western mental health care is an instrument of colonialism and neoliberal globalization. Neoliberal mental health care may not only be ineffective and inaccurate at home, but also wildly destructive abroad. Watters writes, “By undermining both local beliefs about healing and culturally created conceptions of the self, we are speeding along the disorienting changes that are at the very heart of much of the world’s mental distress. It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric.”
I’ll be continuing this research for my bachelor’s thesis on the role of “mental health” in neoliberal society. As that paper develops, I’ll try to post more excerpts and tidbits here on the blog.