A new year invites reflection on how we want things to be different. It’s hard to believe that as recently as twelve months ago, the impending coronavirus — and the vast socioeconomic inequity it now exposes in stark relief — had yet to reach public awareness. As we survey the magnitude of political, economic, and social disparity on which corporate interests quite literally continue to capitalise, how do we situate ourselves psychologically for 2021?
A lot rides on answers to this question because we have long known that the personal is political. Despite ongoing oligarchical attempts to deflect recognition of this, individual and collective well-being are intertwined. So what kind of person do we aspire to be in the kind of society in which we live?
Subjectivity under neoliberalism
Contemporary neoliberalism presents a distorted reading of autonomy in which individual interest is celebrated at the expense of the social input and effort which makes it possible. But since its emergence in the historical context of the eighteenth-century European Enlightenment, liberal ideology per se has failed to recognise the extent to which ‚the self is a product of social processes, not their origin‘.
Issues of identity are now prominent in public debate. But personal identity is constructed relationally, by social and group processes of which the liberal tradition has long taken insufficient account. In illegitimately counterposing ‚individual‘ and ’society‘ — one of many dichotomies on which the liberal tradition rests — individuals are detached from the social contexts which shape them.
In contrast to classical and current neoliberal premises, we are interdependent rather than autonomous.
This applies to mental health no less than to politics and economics. It also has implications for what it means to be well in globalised societies.
Parallels and also pathologies between internal and external regulatory systems are clear. The `dysfunction of key regulatory systems — both individual and social — were observed nearly two decades ago: „The signs that something is amiss in our inner mechanisms of control and restraint are everywhere… Not only physicians and traumatologists but sociologists are pointing out parallels between growing rates of individual and societal trauma.“
Both are escalating in the current period. The impacts of the coronavirus, raging fires in many parts of the world, and environmental devastation are obvious illustrations. Their wide-ranging impacts are compounded by the erosion of the public sector and services and by pervasive corruption (for example regarding the recent explosion in Lebanon) and the calculated policies of austerity.
The parallel between external and internal system failure continues to be marked. The recent text Deaths of Despair and the Future of Capitalism charts in disturbing detail the relationship between socioeconomic devastation and psychological and physical destruction such as declining marriages, and increased rates of suicide and addiction. Yet our culture remains replete with compartmentalisations which are ruthlessly and shamelessly exploited by neoliberal oligarchical interests.
It is simply incorrect to counterpose autonomy and dependence. The mantra of individualism notwithstanding, life is inherently relational.
Mental health is routinely described in individualist terms. But how is psychological well-being possible in societies which are unhealthy?
A Turkish psychiatrist and clinical psychologist have described how integrated psychological functioning is disrupted by societal (not just ‚individual‘) processes under the oppressive conditions of late capitalism. This can occur both by over-stimulation (eg. exposure to 24/7 media cycles) and under-stimulation (via the absence of meaningful work, underemployment or no paid work at all).
Emotional well-being is not influenced solely by temperament or ‚the family‘ in isolation. It is shaped by wider societal structures in which increasing numbers of people across the globe struggle not only for basic economic subsistence, but also for minimal conditions conducive to coherent psychological functioning.
Mental health has become corporatised
The misconception that ‚private‘ and ‚public‘ can be counterposed feeds the illusion that our ‚internal‘ and ‚external‘ worlds are discrete. While we know that this is not the case (e.g. the subliminal power of advertising) we may feel differently. In his aptly named text The Political Psyche, Andrew Samuels notes that “subjectivity and intersubjectivity have political roots; they are not as ‚internal’ as they seem.” The reality is that in neoliberal societies and economies, few domains are immune to the influence of market forces.
The values and priorities of the ‚psy‘ professions, no less than other industries, are underpinned by the tenets of the liberal culture in which they operate. Psychiatrist and cultural critic David Healy is explicit that as far as the dynamics of late capitalism are concerned; the field of psychiatry is no `special case’. His claim is that the advent of ‚a new corporate psychiatry‘, paralleling the rise of corporate capitalism, raises issues we have barely begun to address:
“Galbraith has argued we no longer have free markets; corporations work out what they have to sell and then prepare the market so that we will want those products… It works for cars, oil, and everything else. Why would it not work for psychiatry?”
Indeed, the strength of corporate culture – and the capacity to market as much as treat `disorder’ – displaces the authority of medical discourse itself. This is because the marketing of science shapes cultural beliefs not only of how we regard experiences of depression, but how we regard health and normality.
Healy speaks of a shift which is as much commercial and cultural as medical and scientific. Comments he made over a decade ago have new salience in light of how far the phenomenon he describes has taken root:
“A huge gap has opened up between what is scientifically demonstrable and what people believe, pointing to a cultural phenomenon that lies well beyond the `medicalisation’ so worrying to sociologists and bioethicists…There is something here that reaches down to the level of the myths we make to live by. Our ideas of what it means to be human are at stake.”
Pharmageddon conveys both the power and public health risks of an industry which has the capacity to market (and not just treat) what ‚disorder‘ is considered to be. The capacity of corporate psychiatry to shape the deepest reaches of our subjectivity is disturbing.
Diagnosing the polity
Oppression exists within, as well as outside, ostensibly democratic countries. Yet this remains difficult for many to acknowledge, because oppression is defined by liberal ideology as external to western societies. Like the capitalism it enables, and as Yanis Varoufakis points out, neoliberalism facilitates both spectacular technological innovations and new forms of depravity. But its capacity to corporatise and commodify mental health — to the point of shaping ‚what it means to be human’ — is an insidious form of reach which remains less recognised because it is less obvious.
Consistent with the claim that oppression is enacted in ‚the everyday practices of a well-intentioned liberal society‘, the corporatisation of mental health has occurred in part because of attempts to regulate the environment in which medication became available. Yet changes in the patenting laws of the 1960s accelerated the prevalence of antidepressants in western societies, at the same time as making many new drugs inaccessible to the most vulnerable populations of the world. The current monopoly of COVID vaccines by so-called `developed’ countries is a striking continuation of this inequity.
The patenting laws were also a further step in the privatisation of research and knowledge which has been compared to the loss of land held by English villages and communities prior to the sixteenth century enclosure laws. In an ironic inversion, social problems are privatised in neoliberal economies and individuals are held to be responsible for their distress. Depression, emotional blunting and desensitisation increase as attempts to meet the `norms’ of mental health become increasingly difficult in increasingly inequitable societies
Depression has long been regarded as an epidemic within western societies and is now concurrent with a literal pandemic. The manifest failure of the governments and neoliberal economies of the UK, United States, and many European countries to safeguard public health in the age of the coronavirus is apparent to all. The mental health impacts of this mismanagement are only beginning to reverberate.
Developing countries can indeed teach rich countries about how to respond to a pandemic. Their strategies of `doing more with less’ highlights the disparity in ethics, as well as resources, between what it is no longer appropriate to describe as the `developed’ vis a vis `developing’ worlds. What are the implications in terms of the kind of person we might aspire to become for those of us who have the luxury to ponder the question? How we begin to answer this question depends on how we define `person’, and the qualities and attributes which distinguish personhood.
Becoming a person
While widely taken for granted, the qualities that define personhood are debated in various disciplines. In considering the role of consciousness as sufficient criteria, neuroscientist Joseph LeDoux poses the provocative questions: ‚Does a person have to be human? Are all humans persons?‘. Contrary to popular belief, the terms ‚person‘, ‚individual‘ and ‚human‘ are not synonymous.
One of the several reasons for this becomes clearer when we consider the sad but incontestable fact that being human is not at all inconsistent with behaving in ways which are widely regarded as inhumane. The continuing legacy of liberal counterposing of ‚individual‘ and ’society‘ is pernicious in deflecting attention from the crucial importance of the social contexts in which we exist and which profoundly shape who we are and can become.
The kind of person we are — and how kind we are in the sense of generosity, cooperation and care for others – cannot be considered in isolation from the characteristics which are promoted and rewarded (or conversely discouraged and penalised) in the societies we inhabit. Yet in privileging market-place ‚individualism‘, consciousness, and rationality (which is frequently deployed to rationalize the results of unbridled competitiveness) there is little in the ideology of liberalism that speaks to ethical capacity or need.
Self-interest is self-evident. But it is far from all that motivates human beings. It is also a tenet of liberal and neoliberal ideology which needs to be reappraised. This is because there are major senses in which concern for and about the needs of others is conducive to our own well-being. The limits of perceived self-interest detached from ethical concern are apparent in the case of Arturo Lascanas. A self-confessed hitman and subsequent accuser of Philippine President Rodrigo Duterte, Lascanas was described as ‚dishevelled by guilt’ on implementing orders that violated a moral code he hadn’t paused to consider he possessed.
Indifference to the well-being of others entails personal costs as well as benefits for persons who are not sociopathic. And the absence of empathy precludes the status of personhood in the full sense of the term. It is in our own interests to work towards the type of societies in which the well-being of others is a consistent high priority. If human beings act in ways which are unconscionable — if we lack or lose access to our consciences — what kind of people do we become?
The views and opinions expressed here are those of the author and do not necessarily reflect DiEM25’s official policies or positions.
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