Socially, the dual strategies of exalting consumerism and increasing control have been central to the neoliberal project. Consumerism and control can be viewed as opposite sides of the same coin. People are encouraged to aspire to ever greater levels of conspicuous consumption, modelled after the lifestyles of a celebrity elite that is plastered all over the media and broadcast into everyone’s living room. Shopping, which was once a means to an end, has been transformed into the UK’s favourite leisure pursuit. At the same time, however, more and more people are excluded from the workforce (sometimes forever) by the movement of industry to areas of cheaper labour, and many others are stuck in low paid work with no prospect of advancement. Large portions of the population are only able to achieve the widely advertised ‘ideal’ lifestyle through illegal means. A highly unequal, consumer-oriented society entices people to break the law, which was illustrated dramatically by the riots in London and other English cities over the summer of 2011.
Neoliberalism requires expanded mechanisms of social control to police the lawlessness and social fragmentation that its policies produce. Levels of imprisonment have been rising in many western countries, reaching staggering proportions in the United States in particular. In 2011, 0.7% of the US population were in prison, with 2.9% in prison, on probation or parole. Among African Americans, almost 7% of adult men were in prison, and one in three African American men can expect to go to prison during their lifetime. ‘In the US’, comments David Harvey, ‘incarceration became a key state strategy to deal with the problems arising among discarded workers and marginalised populations’. Rates of imprisonment in the United Kingdom have also been rising, almost doubling since the early 1990s.
The dual drive to increase consumption and control the casualties of wealth redistribution is bolstered by modern, individualistic notions of mental wellbeing and mental abnormality. Even before the age of ‘neurobabble,’ ideas like ‘mental illness’ located problems with behaviour and emotions within the individual, usually in a defective brain, but sometimes in subconscious mechanisms or defective cognitive structure. In this way the complex nature of how people relate to each other and to their environment was dislocated from its social context. In recent years, almost all human activity has been claimed to be explained by neuroscience – from economics to the appreciation of literature. These ideas sit well with neoliberal thinking, with its emphasis on the individual and its distaste for ‘society’.
The concept of mental illness is useful partly because it provides a conveniently elastic justification for control and confinement to complement the criminal justice system. Once someone is labelled as sick and needing treatment, almost anything can be justified. As soon as the bizarre, disturbing and occasionally disruptive behaviour we call mental illness is attributed to a brain disease, its origins and meanings no longer have to be understood. It simply has to be corrected, with drugs or Electroconvulsive Therapy (ECT) or whatever else it takes. Normal considerations of the autonomy of the individual can be dispensed with. ‘Health’ trumps freedom in mental health law.
Neoliberal policies breed communities that no longer have the resources or the motivation to accommodate difference. As people are increasingly displaced from family and friends, as social support networks collapse and as work becomes casualised, the social integration that helped some people withstand emotional pressures in the past is often no longer available. Psychiatric facilities are in demand to manage the consequences, and the language of mental illness enables this to be done without revealing the social breakdown at its root.
In England, over 50,000 people were forcibly detained in a psychiatric institution during the year leading up to April 2013, which was 4% higher than the figure for 2010-2011 and represents an increase of 14% since April 2007. This is despite strong financial and political incentives to reduce the use of hospital beds.
The idea that mental disturbance is a disease that is easily amenable to treatment has also enabled the extension of control out of the hospital and into the community. In 2008, a ‘Community Treatment Order’ (CTO) was introduced in England and Wales that allows patients to be treated against their will while they are living outside hospital, even if they have no ‘symptoms’ at all. The orders do not require that people have a history of violence or suicidal tendencies. A CTO can be made simply on the basis that, without treatment, the person presents a risk to their own ‘health’.
When they were introduced, it was estimated that approximately 450 CTOs would be applied per year. In fact, over 6000 were made in a year and a half to April 2010. The use of these orders continues to rise, with a 10% increase during the year between April 2012 and April 2013. Community Treatment Orders almost always stipulate that the individual has to receive drug treatment that they do not want and do not like. Potentially, someone can be forced to receive these mind-altering chemicals for the rest of their life, even if they have full capacity to make decisions about their treatment.
As well as helping the prison system to deal with the fallout of neoliberal policies on individual stability and community cohesion, the more mundane medicalisation of unhappiness has also bolstered the neoliberal project. The promotion of the idea that depression is a common medical condition caused by an imbalance of brain chemicals has helped displace responsibility for suffering and distress away from the social and economic arena onto the individual and their brain. The mass prescription of antidepressants reinforces the idea that it is individuals who need fixing, but psychological solutions, such as CBT (cognitive behavioural therapy), can also perpetuate this way of thinking.
Some of the reasons so many people are currently identified as depressed likely stem from the same factors that have led to the rising prison population – that we are encouraged to want what we cannot easily get. Sociologist Zygmunt Bauman talks of how consumerism is driven by producing and maintaining feelings of inadequacy and anxiety. People cannot be allowed to feel satisfied. There must always be a lingering discontent to drive people to consume more, coupled with the fear of becoming a ‘failed consumer’. Yet, for many, work has become increasingly pressurised, insecure and unrewarding and as demands for increased productivity and efficiency increase, more people are excluded from the workforce through sickness, disability or choice.
Debt, as well as crime, is used to fill the gap between aspiration and income. But with debt comes stress, anxiety and feelings of vulnerability and loss of control. There are so many opportunities to fail, and ‘success’ is ever more improbable.
The proliferation and expansion of mental disorders creates myriad possibilities for failure. As varying moods, inadequate attention and excessive shyness are pathologised, more and more people are encouraged to believe they need to get themselves ‘fixed.’ Just as cosmetic surgery promotes the impossible ideal of eternal youth, so mental health promotion increasingly suggests there is a perfect state of mental health to which we all need to aspire, and which we need to work on ourselves to achieve. People are encouraged to exist in a perpetual state of frustration and disappointment with themselves, looking ever inward so they do not think to challenge the nature of the society they inhabit.
Ideas about the nature of mental health and mental abnormality are intrinsically linked to the social and economic conditions in which they emerge. Neoliberalism and its ‘no such thing as society’ champions have helped to produce a biological monster that subsumes all areas of human activity within a neuroscience paradigm and, by doing so, banishes the philosophical tradition that acknowledges human experience as irreducibly social. We can only begin to challenge this impoverished view of humanity when we understand its political functions and the ends it serves.
The psychological is political!
By Joanna Moncrieff | @JoannaMoncrieff