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Rob Dellar: Capitalism is bad for your mental health

Rob Dellar's talk to AMM#11
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Paper read by Rob Dellar at AMM#11, 21 Jan 2015, Housmans Bookshop

AMM#11This meeting was suggested by Ben Watson, initially inspired by his reading of Peter Sedgwick’s 1982 book Psychopolitics which led to some behind-the-scenes debate amongst some of us. This is also very timely. Although it is long out of print, leading sociology and psychology academics specialising in fields of health are currently returning to this work, in the belief that it could help inspire a workable platform in opposition to the current round of cuts and privatisation affecting mental health services, and the promise of far more especially if the Tories are re-elected. For example, there’s a high-profile Psychopolitics conference being held in Liverpool this summer organised by editors of the influential “Asylum” magazine, which they hope to use to develop this platform. This comes in the context of a neo-liberal ideological model called “the recovery model” which, over the past five years, has come to dominate the planning and provision of mental health services and now has hegemonic status. Briefly, this holds individual “sufferers” of mental distress responsible for both the causes and the overcoming of this distress, with individually tailored and increasingly privatised care programmes which largely prevent service users from meeting and having the chance to organise, sidestepping any social responsibility for distress and the response to it, and overlooking issues we share including, to name just a few, housing, education, welfare benefits which of course are under threat, and the whole competitive model of capitalism. People like me are now excluded from paid mental health work even in the voluntary sector, because we have to demonstrate not only an “understanding of” but also a “commitment to” the recovery model to meet selection criteria for jobs – which is tantamount to making us promise to vote Conservative if we want officially recognised roles in the sector.

In this context, it’s not surprising that Sedgwick is being revisited. There’s precious little perfect-bound and well-formulated work even approaching the realm of political philosophy relating to our responses to mental health, and without a doubt, Sedgwick’s ideas are extremely useful to any progressive debate as, I will argue, are some of the ideas of the man he seemed to hate more than anyone else in the world – RD Laing. I don’t know a great deal about Sedgwick the man, other than that he was a committed activist in what has been described as the “libertarian” wing of the IS, out of which grew the SWP which I believe he declined to join. He was a psychology lecturer turned politics lecturer, and he wrote a bit. I’d be fascinated to learn more; but perhaps what’s most relevant is the written work left behind after his tragic and as yet not fully explained death at the age of a 49 in a canal in the North of England in 1983.

As a long-term mental health activist, Mad Pride co- founder and occasional dissident “professional,” I have admiration for much of Sedgwick’s work, as well as some problems with it. His central critical thesis is that what came to be known during the 1960s as the “anti-psychiatry” movement bolstered, partly by accident and partly by design, right-wing attempts to dismantle welfare services for those labelled “mentally ill” and indeed in for the public in general, by amongst other things undermining the medical model of mental health, leading to the risk of the assumption that mental distress does not exist as a discrete category, and therefore should not be treated by specialised services. At the time Sedgwick was writing, long-stay and then even short-stay psychiatric hospitals were in the process of being closed down and replaced by community services which were inadequately resourced. Thirty odd years later, even these community services are being dismantled in the name of the “recovery model” which sees even these as institutional distractions from what it perceives as the entirely individual, identity-based nature of rightful responses to distress. The academics now wishing to habilitate Sedgwick in opposition to this trend argue that, although the author’s arguments might not have been strictly accurate with regards to “anti-psychiatry,” they make perfect sense if you substitute the term anti-psychiatry for that of the recovery model.

Before I address Sedgwick further, and a little digressively, I want to emphasise how real, debilitating and ubiquitous states of experience currently described as “mental illness” are. People with diagnoses like depression, schizophrenia, bipolar disorder and the exponentially growing varieties of “personality disorder” of which there are currently about 500, are affected by these states in ways which very often lead to withdrawal, isolation, hopelessness, confusion, chaos, inability to look after themselves or distinguish fantasy from reality, and all too often, suicide. These situations can often be proven to be caused by concrete social factors. Their progression and the possibility of their alleviation, or at least their co-existence with a decent quality of life are influenced without exception by concrete social factors. Most people suffering from these situations cannot “work” in the conventional ways dictated by capitalism. Hence issues surrounding “madness” have sometimes confused the organised left. “Sufferers” will rarely be shop stewards, do not fit into capital relations in the old-fashioned way, they can be impulsive and “unreliable” and make bad cadre. Largely forming an underclass separate from or at least complicating the conventional formulation of the working-class, it has often been convenient to overlook them. To Sedgwick’s great credit, he wanted to challenge this situation and make “mental health issues” a concern of the left.

For well-documented historical reasons, the definition, classification and social response to “mental illness” has come to be controlled by a profession called “psychiatry” which has manoeuvred itself into being a medical speciality. In practice its role has developed to include the policing of various forms of deviancy, and the application of techniques to suppress or conceal the visible forms of distress that society considers problematic. The most important key to this since the 1950s has been the use of psychiatric drugs, the development and sale of which have become part of a hugely profitable pharmaceutical industry second only to the arms industry in terms of corruption, political influence, lack of transparency and imperviousness to challenge. “Mental illness” – precisely because its terms of definition and the scientific knowledge surrounding it are so vague and some might say primitive – is a prime area for the invention and marketing of pharmaceutical drugs, whose manufacturers’ shareholders rely on doctors, and psychiatrists in particular to distribute them. Psychiatry, in turn, now relies on the political sway of this industry and its lobbyists to maintain its dominance in the field. It’s reached the point where drug companies invent new drugs first, and then following on from this new “mental illnesses” are identified specifically for these drugs to treat. Patients, of course, are left out of this process, except as the often unwilling recipients of these products.

Sedgwick’s principal gimmick was to formulate polemic against precisely those who pioneered opposition to this state of affairs when it was developing, and at times he had good reason. One of the most high-profile figures within what was in fact the quite broad church of “anti-psychiatry” was an American right-wing, free-market libertarian called Thomas Szasz whose ideas unfortunately remain influential. Szasz’s assertion was that mental illness doesn’t exist as a scientifically provable entity, making the medical model of psychiatry superfluous and, in fact, abusive. However, he also asserted that emotional distress doesn’t exist either, and that we should ignore what might appear to be signs of it. He argued that “states of mind” were immaterial and should, for example, never be taken into account in determining judicial responses to crimes. As an extreme free-marketer, he advocated the abolition of the welfare state including all public health services, covering physical as well as mental “illnesses.” In 1969, he joined forces with L. Ron Hubbard and the so-called Church of Scientology to create the “Citizens’ Commission for Human Rights,” which continues to campaign and make frequent legal challenges against psychiatrists as a front to recruit people it considers mentally fragile, and therefore by its own terms gullible, to its ranks. Szasz thought that any intervention into a person’s suicidal intentions was an abuse of their civil liberties, and that they should be left to get on with it. There’s a whole chapter in “Psychopolitics” devoted to quite accurately dissecting and trashing Szasz’s arguments. Unfortunately Szasz still holds a great deal of sway, particularly amongst young, understandably angry people who may have just come out of hospital traumatised and abused by the psychiatric model for the first time, and who express their grievances within groups like “Speak Out Against Psychiatry” which are also, incidentally, permanent targets for infiltration by Scientologists. Just as unfortunately. Sedgwick’s work influenced the creation of this situation by failing to distinguish between the left and right wings of “anti-psychiatry,” leading to confusion amongst many mental health service users and activists. For him, sociopaths -to use a term incidentally not recognised within professional psychiatry -like Szasz were essentially the same as other people labelled as anti-psychiatrists whose motivations couldn’t have had more different motivations. I’m referring especially here, of course, to RD Laing, who for reasons not entirely clear to me was the greatest and most obsessive object of Peter Sedgwick’s dislike.

As far as I know, Sedgwick’s first public tirade against Laing was published as the opening chapter of the Penguin anthology “Laing and Anti-Psychiatry” initially released in 1971. The book “Psychopolitics” from eleven years later is mostly an expansion of this essay, padded out with chapters about Szasz, Michel Foucault and Erving Goffman, but it also features a seventy page essay at the end entitled “Mental Health Movements and Issues: A Survey and Prospect” which is worthy of separate consideration. To avoid making this too long, I’ll need here to savagely over-simplify Laing’s work and Sedgwick’s responses to it, and be very selective, but I’d recommend that everyone reads in particular Laing’s books “The Divided Self,” “Sanity, Madness and the Family” which he co-authored with Aaron Esterson, and “The Politics of Experience,” as well as Sedgwick’s “Psychopolitics” which in fact I hope gets reprinted soon. All of these books are accessible reads.

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During his chequered career, as Sedgwick points out Laing addressed mental health issues from a number of perspectives and some were far more useful than others. Laing began in the late 1950s, in the very early days of psychopharmacology, by presenting in “The Divided Self” people labelled with “schizophrenia” who either he – as a psychiatrist himself – or his predecessors had worked with, showing how their behaviour can be shown to be intelligible considering the situations they were in, for example as hospital patients, and as members of group units like families. In doing so Laing, radically at the time, seemed concerned entirely with the patients’ own experiences in these contexts – something Sedgwick never really considered. Although it is true, as with Laing’s subsequent work, that a collection of case studies constitutes far less than empirical evidence that can be universalised, he suggested compelling models that, in my own experience working and agitating within the misery industry, are very often applicable and as such essential ingredients of the tool-kit of anyone who seriously wants to help people in emotional crisis. Laing concluded that his studies problematized the construct of “mental illness” as a category, separately from other illnesses where more identifiably material and objective physical factors came into play. Sedgwick, curiously, counters this with saying that all illness is a social construct, therefore we should not treat emotional distress as a special case, and that following on from this, we might just as well go along with the medical model of mental health for want of better alternatives. For example, Sedgwick suggests that if we are plagued by a virus, we can say that we are ill, but could you say the same for the virus, which is having a whale of a time? If we “cure” the virally-afflicted patient, it’s simply a case of victor’s justice. This is especially strange because better alternatives to the medical model of psychiatry are in fact implied within Sedgwick’s critique of the entire concept of illness when he points out that a lot of physical troubles are affected by social contexts such as class, and resources of convenience whose applications extend beyond medicine, such as access to clean drinking water and decent housing. The same of course is true of mental health; and yet the conclusions he draws are that attacking psychiatry is counter-productive because it could lead to people in distress being left without any help at all. Here, he glosses over the fact that the medical and social models of mental health are engaged in permanent, bitter competition for recognition, funding and power.

Famously and particularly in the early to mid-1960s, Laing demonstrated that psychosis often became intelligible when the family contexts of those experiencing it were analysed. Again, he presented case studies which should not be over-generalised but which, again in my own observation as well as in that of countless patients who have told their own stories, are applicable quite frequently and should be part of the tool-kit of those working to help relieve distress. So-called mental illnesses nurtured in the first place in the family context are manifold, but it is as if Sedgwick cannot bring himself to believe this. Firstly, his pragmatic model of helping to address the issues of emotional suffering foregrounds the role of families as carers, sometimes explicitly at the expense of patient’s own insights. Secondly, Sedgwick objects to the analysis of family units because of what he calls their “micro-social” nature. His interpretation of socialism seems such that “macro-social” factors must always take precedence, and that attempts to make explicit the links between the two, as Laing occasionally did, are somehow counter-revolutionary. I don’t know what Sedgwick’s experience of his own family life was like. Perhaps, unlike Laing’s, it was a bed of roses; perhaps not, but his ridiculous caricature of Laing’s description of a dysfunctional family unit, which incidentally appears on pages 82 to 84 of “Psychopolitics,” seems to go far beyond the simply scholarly. Maybe there’s something personal going on here.

A criticism made of Laing by Sedgwick and others, which has some validity, is that his veering towards mysticism and transcendental speculations, notably in his 1967 work of psychedelia “The Politics of Experience,” detracts from engagement with the material causes of distress and from the task of overthrowing capitalist property relations necessary to tackle these causes. Like many others, Laing was taking a lot of acid in those days, and at times confuses the experience of an LSD trip with that of a psychotic breakdown; the differences between the two are numerous and it would take up too much space to explain them in detail. Sedgwick accused Laing of romanticising an illusory “pre-social equilibrium” and there are times when you can see what he means. But Sedgwick’s analysis of this period of Laing’s career is not only selective; it also glosses over fascinating and what some would call idealistic implications of his work that should concern those of us fighting today for a world fit to live in, especially if we’re interested in the details of what such a world might look like. Around this time, with his close associates Joe Berke and the more explicitly Marxist David Cooper, He worked on the “Dialectics of Liberation” conference which drew together cross-disciplinary strands of counter-cultural as well as political activism to foment links which still reverberate. Also, he set up the therapeutic , experimental commune Kingsley Hall in Tower Hamlets where people were empowered to live through psychotic episodes, free from mainstream psychiatric interferences such as medication, and see if and how they could emerge at the other side. This had mixed results, and led to Laing’s formation of the Philadelphia Association – principally a network of therapeutic communities across London drawing on the positive outcomes from Kingsley Hall, and taking lessons from its failures. Sedgwick claims in “Psychopolitics” that only middle and upper-class people with independent financial means could make use of any of these projects. I don’t know why he made this claim, but it is false. I’ve known many people over the years living in these set-ups and on the whole, they have found them life-changing in a positive sense. None of them were toffs, and their fees were met by Housing Benefit.

Looking beyond some of its unhelpful mystical obfuscations, the central thesis of “the Politics of Experience” is that psychosis offers glimpses of possibilities of perception and behaviour overlooked within consensual rationality that can sometimes make as much or even more sense. There are endless debates to be had about this, but I’d like to point out that the straight world we inhabit is a bit boring, and events such as the best of the Mad Pride shows have dramatized, if only for a few hours at a time, what we can achieve and, crucially, how good we can feel when we leave it behind. Further to this, it’s clear that so-called “sane” society hasn’t made a very good job of organising things and this has led to atrocious situations such as the dominance of the capitalist model. Laing himself very frequently alluded to this problem. He rarely used the word “capitalism” but broke it down into some of its constituent elements, in particular the atomic bomb and the ubiquity of wars, and this made him ask: Who are we, then, to judge the “mad”?

Laing’s transcendental conceits could at times be very funny. By 1984, Laing was by all accounts burnt out by overwork and alcohol dependency. His most important work was long behind him, and he had spent much of his recent time living in squats with heroin-addicted rock musicians. In the September of that year, he was arrested for throwing a bottle of wine through the window of the Bhagwan Rajneesh centre in Belsize Park dedicated to a Himalayan guru, almost as if he was symbolically rebelling against the mystical traces of some of his past work. However, when the cops turned up, found him outside the centre cursing “the orange wankers” and took him to the station to be charged with cannabis possession and being drunk and disorderly, Laing told them when questioned that he’d thrown the offending bottle “for spiritual reasons.”

The final chapter of Sedgwick’s “Psychopolitics” calls, quite reasonably, for opposition to further cuts and privatisation of services which will decrease the resources available to help those labelled “mentally ill.” He calls for strategic alliances to be made to resist these threats stating, again correctly that we should not wait until after the revolution to ensure situations are in place to alleviate the suffering of those who, for whatever reason, are the most vulnerable to the terrible suffering that “madness” can cause: situations that will for now be provisional, or transitional. Sadly, Sedgwick all but excludes patients themselves from these hypothetical alliances, stating that instead they will be formed from carers and families of the “mentally ill” alongside professionals – including psychiatrists at the behest of the pharmaceutical industry that embodies capitalism at its most pernicious. When “Psychopolitics” was issued in 1982, what is now known as the “survivor movement” was in its relative infancy. However, Sedgwick could surely have written more than the mere two pages he devotes to survivor self-organisation initiatives in the 1970s. As a Marxist, it’s very surprising he chose to go into such little detail about the few whose existence he acknowledged in passing. The German Socialist Patients’ Collective, for example, took as its starting point the premise that “illness” was the appropriate and correct translation into modernity of “alienation” as conceived by Marx, and that “mental illness” in particular was both an embodiment of capitalism and an essential precondition of its supersession. In London, meanwhile, Eric Irwin’s influential Mental Patients Union was advancing an explicitly anti-capitalist critique of psychiatry. They were refusing the role of passive victims. It’s hard to measure Sedgwick’s awareness that without Laing’s influence, this activity would probably not have been taking place.

Even in 1982, the potential conflict of interests between carers, families, professionals and “sufferers” themselves must have been clear. The left’s traditional model, however, was that revolutionary activity would stem from antagonisms between those directly engaged in capital relations – workers against bosses – making what might have been considered an “underclass” less relevant to the aims of self-appointed vanguards. Times have changed; strategies are being rethought; opportunities may be emerging for people forced to use mental health services to assume and be allowed a more leading role in the activities necessary to overthrow capitalism as it now presents itself.

One final reservation I’d like to express about Sedgwick is his apparent, concluding assumption that medical, rather than social services will continue to take the leading role in combating mental distress – a conclusion that doesn’t necessarily follow from all of the arguments contained in his book. Sedgwick’s final word on the subject, just before his premature death, was his letter to the Bulletin of The Royal College of Psychiatrists in 1983. In it, in between attacks on RD Laing, he expresses his opposition to that year’s Mental Health Act replacing the previous Act from 1959, in particular its strengthening of the powers of Mental Health Review Tribunals to over-rule individual psychiatrists’ powers to detain individual patients in hospital indefinitely against their will, and he affirms his unconditional support for the profession, which he suggests is a bulwark against steadily encroaching threats from both populist and bureaucratic elements of the right-wing.

For good reason, well-informed activists from the “mental health survivor movement” will be critical of academics’ attempts to form an oppositional platform to current developments in mental health services policy and provision with reference to Peter Sedgwick alone. This is not to say that the entirety of his work should be overlooked. It is ironic that his greatest enmity seemed reserved not for the right, but for one of his very rare few fellow thinkers deliberately and talentedly engaged with the practical problem of improving the lives of those labelled “mentally ill.” There is no overlap between the useful parts of Sedgwick and Laing’s respective works. It needs now to be the task of more capable brains than mine to establish how these works could interact dialectically to formulate an oppositional platform that truly puts the interests and voices of “the mad” at the heart of demands for their better care.

Robert Dellar, 11/1/15

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