Mad World: The politics of mental health

One morning, in the summer of 2016, my mind split in half. As I opened my eyes to bring the day into focus, the same way I had done every single day of my life so far, I couldn’t quite make things sharp enough. It was as if I hadn’t fully awoken to ​‘reality’, but was stuck in some liminal purgatory between the dreaming and waking worlds.

Everything looked as if it was taking place on a television screen – myself, an audience member watching my own life play out from afar. As the days, weeks and months dragged on, I couldn’t shake this dizzy, detached and anxious feeling, and began to spiral into panic attacks multiple times a day. I found myself in a living nightmare, feeling not-quite dead but not alive either, resigned to the idea that I would either have to relinquish life or accept this new waking death. 

This experience, which lifted after a number of months, was in retrospect one of the most destabilising yet significant periods of my life. It was a time in which I went mad. There is a clinical name for what I was experiencing: ​‘depersonalisation disorder’, a state of ​‘dissociation’ that is linked to extreme anxiety levels. 

People who experience depersonalisation for a long period, like I did, often express relief upon this realisation that they have not ​‘gone mad’. But to me, it was undoubtedly madness; I could feel it in my mind and I could see it in the way that people looked at me when I tried to explain my predicament. Lacking a strong community around me, and conscious of my ​‘unpalatable’ form of distress, I intuitively swallowed my madness.

I only dared to utter it in interactions with various professionals, while treading precariously around the scripted questions that determine whether a person will be sectioned. For so many others like myself, madness and mental distress is an overwhelmingly isolating endeavour under our current conditions. It can cut us off from our communities, make us feel trapped, take over our lives, and see us further secluded within the system – both physically and metaphorically. It can pile on shame, disgust and trauma, turning our days into a struggle to simply stay alive. 

How, then, do we take such alienating and debilitating experiences and turn them outwards to politicise them? This is the central concern that I will attempt to tackle. In recent decades, we have seen an explosion of liberal ​‘mental health awareness’ campaigns, demanding that we ​‘speak out’ and ​‘break the stigma’ around mental health. A slew of memoirs and confessional mental health writing has also followed, dissecting the personal dimensions of distress and providing many of us with narratives that we can ​‘relate’ to. 

Others have begun to interrogate the link between oppression and mental health – for example, the relationship between race, gender and distress. Most of these discussions, however, are yet to make political, historical and economic analyses that are truly radical and grasp problems at the root. While currents in mental health conversations may have shifted and swirled about on the surface, the deep, murky water beneath largely remains the same. We are yet to sufficiently grapple with questions like: how does my experience link to yours? What shared structures and material conditions dictate how we all understand and experience what we call madness or mental illness? What even is madness/​mental illness, and should we take these constructs at face value? 

In considering this, we must mobilise anti-capitalist, ​‘mad’, disability justice and anti-racist thinking in particular to carve out a radical political approach to mental health. We must name the capitalist economic system, specifically, as a significant producer of suffering in contemporary life. Capitalism, a system characterised by private ownership, wage labour, competition and the pursuit of profit, harms each and every one of us. It separates us – workers – from our work; forces us to choose between inhumane working conditions or death; pushes people into dangerous living conditions and houselessness; destroys our environment; sanctions and normalises all kinds of death; forces the unemployed into murderous benefits systems and social institutions; and allows a limited few to accumulate more wealth than they could ever need.

Around 10% of the world lives in extreme poverty. These conditions are largely inflicted on women, young people, children and people living in the ​‘Global South’. One hundred million people are estimated to be homeless worldwide, and as many as 1.6 billion lack adequate housing. More than 60% of workers worldwide are in temporary, part-time or short-term jobs in which wages are falling. Neoliberal austerity has seen healthcare, youth centres, housing budgets and benefits slashed, depriving us from access to bodily autonomy, community, safety, dignity and joy. This is the context in which depression has become the leading global cause of disability. Under these conditions, life is not only unfulfilling for many, but also unliveable. 

On a psychological and interpersonal level, capitalism affects all of us. It infiltrates and corrupts how we fundamentally think about one another. The insidious logics of extraction, exploitation, scarcity and competition impact how we talk, befriend, date and otherwise interact with each other. Capitalism birthed even the most commonplace social structures in which we distribute care, abuse and resources. It is no coincidence that the Western capitalist nuclear family unit is the institution that psychoanalysts have long located at the epicentre of our neuroses. Intimate relationships and marriages – another normalised economic unit – often produce trauma. In this sense, and many others, capitalism fractures community, laying the foundations for isolation and abuse. Its allied systems, for example, white supremacy and ableism, also trap and harm us on a psychic level. 

Throughout the mid-late twentieth century, there was a groundswell of activism and contestation around mental health – in the form of the ​‘anti-psychiatry’ and ​‘psychiatric survivor’ movements, which shared some overlap with other liberation movements of the time. Both movements challenged psychiatry (the dominant medical approach to mental health), arguing that suffering should be seen as a social and political concern rather than an individual one. They also resisted psychiatric power and control, which had allowed for the mass incarceration of mad or mentally ill people in giant ​‘insane asylums’ or ​‘mental hospitals’. From a present-day perspective, it is curious that the histories of these political movements have been erased, while the movements have left little imprint on the ways that mental health is approached and understood today. 

In the current climate, we still largely discuss mental health in terms of individual identity (something we are) and property ownership (something we have) – rather than as a form of collective oppression (something that is done to us). Even in political spaces that are suspicious of state authority, deference to psychiatric ideas is very much the norm. We are scared to touch mental health, usually out of fear of getting the ​‘science’ wrong. I have noticed some of the most vocal and political people I know confess that they lack ​‘expertise’ or ​‘authority’ on mental health, despite the fact that suffering surrounds us in our communities. 

This fear and avoidance, however, reinforces madness and mental illness as a private matter that we must outsource to other institutions. This is the capitalist approach to mental health in disguise; the force that pushed people out of communities and into asylums, disappearing them from public view. Many commonplace utterances around mental health are also distinctly neoliberal – for example, it is standard and even sometimes considered humorous to urge people to ​‘get therapy’ or even to ​‘take their meds’ when they are understood to be causing harm or disruption. This echoes the gradual shift in mental health provision towards private for-profit entities over the last half a century. When we frame mental health in such a way, we bolster the idea that it is each person’s individual responsibility to stay well by seeking out therapists, psychiatrists, psychologists, doctors, self-help books, crisis lines and more recently apps and self-care gurus, many of which are becoming increasingly ubiquitous and profitable in the neoliberal era. While these things may help many survive or conform to the construct of ​‘mental health’, they will never address the root causes of suffering or harm. They also cannot provide us with the tools to transform the world that drives so many of us mad. 

While writing on this subject matter, I never found the perfect language to describe it. At the time of writing, ​‘mental health problems’ is perhaps the dominant term – simultaneously shirking and embracing the language of ​‘illness’. Some prefer ​‘mental illness’, and feel that it accurately describes their experiences. I want to offer autonomy to the reader in making sense of these contentions. To show that, while the state currently favours ​‘illness’ as an explanation for some forms of suffering and nonconformity, it is not the only way of thinking about these experiences. 

Many of the arguments I make are guided by my commitment to the disability justice movement, a movement pioneered by disabled people of colour, which takes a radical and intersectional approach to the liberation of disabled people. Some of the more unconventional arguments I make – which simultaneously resist psychiatric control, but also challenge historical ​‘anti-psychiatry’ movements – are unique precisely because they are grounded in disability justice. This approach also informs my language choices. Each sentence relates to a set of concerns that may cease to exist in a world that was transformed. 

I want to grapple with issues like the incarceration and punishment of mad/​mentally Ill people; the emergence of these approaches under the capitalist system; the push to understand madness/​mental Illness in one, restricted way; the maddening nature of racism, transphobia and wage labour; and the pathologisation of marginalised people. All of these issues are tied to what are sometimes called the psychiatric and medical industrial complexes – systems that emerged under capitalism to largely serve capitalist ends. In a different world, our conditions could be transformed beyond recognition, and so it follows that our approaches to mental health would also be unrecognisable. We could be in control of our own labour, our own healthcare, our own healing, we could choose how we name ourselves rather than having labels enforced on us. We could ensure that everyone had the resources, infrastructure and support to live in the community. Resources could be reallocated in such a way that health would flood out of closed spaces and into everyday life. Our living and labouring conditions would lead far fewer people to suffering and sickness in the first place. Our conception of mental health could be transformed too.

Regardless, I hope that this will be a jumping off point. I offer it with humility. There will be holes in it, contradictions, cycles and repetitions, things that in the future are discovered to be inaccurate, incomplete, blinkered or a product of their time. 

This reflects the spirit of madness, but that is okay, because this project demands a sort of mad thinking. After all, what is the utility of ​‘sanity’ or ​‘rationality’, in a world in which ​‘sanity’ means the death of oppressed people and the planet, and ​‘rationality’ means the logic of the market? In this climate, it is madness that will help us burst beyond the ​‘rational’ confines of the asylum, of the prison, of capitalism and individualism. As the world drives us increasingly mad, it is crucial that we take mad knowledge seriously, and acknowledge its imaginative potential. This journey began when I woke up in a dissociative dream. I believe various forms of dissociation, dreaming and escape from this world are the only way to transform it.

Mad World: The Politics of Mental Health is out on 5^th July on Pluto Books.

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