What is an ordered mind? As labels of disorder continue to proliferate, and diagnoses remain harmful and hard to shake, the configuration of the boundaries between sanity and insanity is of central importance to any transformational politics.
In its fifth edition published last year, the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the American Psychiatric Association’s (APA) bible – now boasts a total of 380 mental disorders (the first edition, released in 1952, featured 106.) This diagnostic expansionism has led to a situation in which the National Institute for Mental Health found that between 2001-3, 46% of Americans fit the criteria for at least one mental illness. A historical tradition of imposing order by seeking out and confining deviance now finds its logic threatened by the approaching majority it confines.
In recent editions of the DSM, a clear pattern of pathologising everyday life has emerged. Children as young as two have been diagnosed with Childhood Bipolar Disorder, heavily medicated and regarded as victims for life, for showing symptoms such as ‘moodiness’ and a proclivity for ‘temper tantrums’. Elsewhere, “solastalgia” (existential distress caused by environmental degradation) has been referred to as a psychiatric illness. Environmental destruction harms us all, but that the reaction to this devastation should be to medicalised and subsumed into individualised diagnostic processes speaks directly to the “logic” of biomedical psychiatry. Whilst “solastalgia” hasn’t yet made the DSM, the conditions under which such a classification might be made remain.
The foundations of western psychiatry are amplified by, and cannot be disentangled from, the nature of capital. The APA, a body that serves its members, not patients, has tightly-guarded intellectual property rights over the DSM (pocketing over $100m from DSM-4 alone) and the pharmaceutical industry is one of the most profitable on the planet (The NHS in England spent £270m on anti-depressants in 2011). The impact of capital on the nature and behaviour of the psychiatric profession cannot be underestimated.
69% of those who drafted DSM-5 had financial ties to the drug industry. As the pharmaceutical industry searches relentlessly for new markets and sources of profit, it needs the psychiatric profession to expand the intellectual architecture that necessitates pharmaceutical “cures” as well as paving the way for expansion of the western biomedical model of mental illness into untapped foreign markets.
The pharmaceutical industry also funds and sponsors the vast majority of drug trials and psychiatry conferences and functions. In effect, some of the most powerful corporations in the world are able to omit studies whose results, if published, could reflect badly on their products. In this way, the scientific method is utilised to obscure far more violent social relations.
An illuminating parable highlighting the bogus logics of western psychiatry and the ignored importance of social context can be found within the Gay Liberation movement of the 1970s. Homosexuality had been defined as a mental disorder in the DSM until 1974. It was removed from the ‘jurisdiction’ of psychiatry not because of some compelling scientific breakthrough but by class consciousness and the concerted political pressure exerted by gay people, specifically in the US, taking collective action against the psychiatric establishment and within society more generally. Gay rights activists disrupted the APA convention in 1971 where Frank Kameny seized the microphone and shouted: “Psychiatry has waged a relentless war of extermination against us. You may take this as a declaration of war against you.”
The upshot of all this points us toward a far more social, political and economic explanation for both the variety of mental experience that exists throughout humanity and for the systems, ideologies and disciplinary apparatus that have developed historically around notions of madness. In arguing against medicalisation, we don’t seek to minimise or discount suffering, nor suggest that identification with diagnoses or symptoms is wrong. What’s important is to underline the structural argument that the performance of power excludes, divides and categorises in order to maintain control.
In mainstream political discourse, words like “insane”, “loony” and “crazy” are frequently used by politicians and media in an effective process of political othering. Those (other than the state) who commit “violence” or anyone from perceived ‘extreme’ poles of left or right can be safely discounted from the ‘grown-up’ arena of the possible, occupied by all who uphold a politics of common sense in which the future is impossible. Who could deny the immanent sanity of liberal democracy? Mental health charities and media campaigners bolster this process of discursive containment with a language of ‘inclusivity’ and empty PR. In doing so, they make the ‘vulnerable’ and ‘marginalised’ into pleading victims, sanitising an anger that should instead be weaponised.
The conditions of late capitalism, left unmentioned and unanalysed throughout mainstream discourse surrounding “the modern epidemic of mental illness”, are practically tailor-made for the mass production of stressed, insecure, isolated and alienated subjects. Whether it’s the systemic centrality of personal debt, the casualisation and precarisation of the labour market or the concerted attacks on those claiming social security, neoliberalism is a factory for the production of misery.
A revealing Gallup poll from June 2013 found that 50% of American workers describe their approach to their jobs as ‘just going through the motions.’ A further 20% said they felt ‘disengaged’ from their jobs, hate their work and ‘actively put energy into undermining it.’ Closer to home, a study at Warwick University five years ago revealed that while 12.9m days of economic output each year was lost to strike action at the height of the crisis-ridden 1970s, 13.5m working days a year are now lost to “stress-related illness”. The death of collectivity has seen an industrial action – that at least held some sway in power relations – give way to individualised withdrawal from the unbearable.
The restructuring of the labour market in the form of zero hours contracts, affective labour, and the cult of managerialism with its suffocating targets, meaningless paperwork and micro-management are key causes of misery and alienation. Equally, the inability to meet the demands of the ‘society of work’ causes or exacerbates mental strains for the millions put through exploitative workfare schemes and the DWP and Atos’ “fit-for-work” witch hunts. The courts even found in May 2013 that the Government’s Work Capability Assessments discriminated against those with mental health diagnoses. Furthermore, a strong philosophical current runs right through NHS psychiatric services which is convinced that, above all, it is the ‘society of work’ that will set you free, and by extension the surest marker of “recovery” is one’s willingness to submit to normalised modes of labour (reproductive and/or waged).
Of course there is a long, rich and varied history of resistance and struggle inside and outside of the psychiatric system. The anti-psychiatry movement rose and fell in correlation with accompanying radical social movements of the time. Contemporary movements must also question the role of the mental health system in society and support alternative, non-coercive approaches such as the Soteria and Hearing Voices networks.
The disciplinary architecture of mental illness in society intersects deeply with other struggles. You’re more likely to be diagnosed with schizophrenia if you’re black as well as disproportionately more likely to be sectioned and die in the custody of the state. You’re more likely to be preyed upon by loan sharks if diagnosed or perceived to be mentally ill just as the poorer you are or less social capital you possess the harder it is to access services, stay afloat financially, escape or withstand attacks from the DWP, challenge your diagnosis or simply find the time and space to rest and recuperate.
This struggle overlaps with issues like housing, drug abuse/addiction, prison and “rehabilitation” and with the general tendency of the state and capital, throughout history, to exclude and confine parts of the population – the old, the infirm, the mad, the disabled, the queer, the troublemaker, the unemployed – that are not “productive” and make it harder for them to remain in power and control their terms of rule.
There is little that connects our lives more than a shared sense of alienation. An alienation of the body and the mind that stems from how we are forced to relate: to work, to space, to nature, to the state and to each other. Popular imagery has the alienated figure of ‘The Madman’ wearing a sandwich board, walking around Oxford Street or Times Square, proclaiming loudly “THE END IS NIGH!”. But given factors such as the round-the-clock climate extremes experienced globally, does this not now seem perfectly rational? Within this situation it is impossible to sustain the pretense that states of mind conform to the grammar of brain chemistry; that any resistance to the order of things is not the sign of competing ideology, but of a pathology.
What is an ordered mind? Perhaps the question is upside down. What would madness be in a world with uprooted power structures, reimagined language and transformed social relations?