There is much in conversation about ‘mental health’ these days. To the point it feels like a buzzword. Very often the extent of these conversations is in our need to do some ‘self-care’, which in my case means eating a whole 16” pizza and going to sleep. Everyone these days seems to visit therapists and it seems like a societal norm. But for all the time I personally have spent at a doctors office deciding whether I should talk about my suicidality, very little has come of it beyond me starting an agenda for the 200th time and considering ‘starting a business’ with my specific skill set.
Nevermind my romp through CBT where I was helpfully told if I could reframe my mode of thought about my boss firing me, maybe I would starve less. For the 4 years I have spent in therapy, I have gained very little from it. When I am worried about whether I can graduate and gain meaningful employment in the future, very little eases my discomfort other than meaningful employment or a sense of security. Very little can my doctor do when my grocery bill has increased on average 30% in the last year, and I spend most of my day worrying if I spend too much on groceries.
With a rapid increase in people seeking out mental health treatment, many people have pointed out that what we are witnessing is an epidemic of sorts. Articles speak of how unemployment, job, food, and housing insecurity play a drastic role in mental health.
However, society has not reflected on our current method of coping with these material issues. The recourse after the conversation seems the same regardless: prescribing us medication or sending us home, no more the better. One cannot adequately begin this conversation without doing an analysis on the material realities of history and any corresponding relations to mental health. We need to draw real connections. Are improvements in psychiatry, and uptake in mental health institutions comorbid with the economic crisis?
When we look at the birth of psychiatry as a practise, we can see that it reached legitimacy during World War I partially because of Freud's work. During this time Freud created some of his seminal work, including Introduction to Psychoanalysis, a compilation of Frued’s speeches, being given in 1916-1917 in the middle of World War I. Use and study of lobotomies similarly saw their climax during a crisis, namely the Great Depression. According to Roy Porter in Madmen, patients in institutional care went from a few thousand in the 19th century to over 100,000 by the early 20th century with the dawn of industrialism.
In a more contemporary example, according to Statistics Canada, “since COVID-19, fewer Canadians report having excellent or very good mental health – 55% (July 2020) down from 68% (2019).” Further, it is a well accepted fact that your status as a minority plays a big outcome not just on your physical health but also on your mental health. It seems obvious on a cursory glance to say that mental health is tied with quality of life, yet we as a society seem unwilling to take the next step in that conversation, alleviation.
What has been missed by us in these moments is that the alleviation of the suffering of these people has been largely done not by the existence of new therapies or incredibletherapists but by the struggles of socialists and workers against these oppressive systems. We are willing to make the connection at least on a shallow level that poor life quality for an individual leads to negative mental health outcomes. Further, we are willing to accept that many of the problems faced by individuals are systemic in nature, such as evictions due to the 2008 financial crisis. Yet we as a society, and doctors in particular, seem unwilling to go a step further.
We are unwilling to admit that the alleviation of these material systemic issues would mean better mental health outcomes for individuals. These issues would be alleviated by the winning of better working days, of sufficient wages, of free child care, etc. Doctors by no means suggest that they are the arbiters of a utopian society. Yet all the same, they fail to recognize the systemic factors in the large scheme of their work. They incidentally center themselves and their atomized solutions as the only legitimate form of treatment and fail to recognize the work done by others in alleviating the same problems.
The hallowed work of psychiatry often sidelines and dismisses the work done by social workers as menial. However, at a cursory glance, beyond the medication, it is the social worker who helps one find adequate housing, food and time to do healing. However, this work by and large is relegated to a low wage and seen as a lower form of work. This is not to mention how these workplaces are dominated by women, while the higher prestige doctoral work is dominated by men. The reality of the situation is that by and far, it is hard to make a ‘profit’ on this kind of labour, as often doctors need to interact with a patient for an hour at most to ‘diagnose’ them. The work done by women social workers involves dedication and patience with individuals, people under their care cannot be medicated and sent out. However, there is a concerted effort by governmental institutions to divest from this kind of work explicitly, often leaving the modern social worker with limited resources with which to help those that seek their help. That being said, at the same time, there needs to be recognition of how these social work institutions also co-mingled with colonialism and imperialism to take children away from Indigenous people all over the world.
Regardless, we as a society must reckon with the facts, with the analysis, that we will never get better until we abolish capitalism, that the alleviation of this mental health epidemic is not a mandated ‘vaccine’ where everyone sees the therapist every week, but by the abolition of the institutions and social pariahs that drink dry the workers. This is a fact that needs to be announced by our doctors at every level, otherwise they are no better than the bourgeois that they send us back to work, repaired enough to keep working but nothing more. We need to unionize, fight for better material conditions for each other. We can follow in the line of Actually Existing Socialist states such as China which went from having one of the highest suicide rates in the 90s to the lowest by mid 2011. China has done this on a mass level not by creating incredible mental health programs, but by addressing issues of poverty, by increasing access to better paying jobs, to decreasing working hours, and creating social safety nets for people who are in crisis.
Further, credit has to be given to those fields that acknowledge these material realities of mental health and work to alleviate them, such as social workers. This needs to be the headline into any discourse about mental health, that we cannot do anything to alleviate mass suffering without mass struggle, that we are doomed to a cycle of playing word association with a doctor until we can win a socialist society.