A review of Iain Ferguson, Politics of the Mind: Marxism and Mental Distress (Bookmarks, 2017), £9.99
The current crisis in the National Health Service is at its worst in the field of mental health. Since the Conservative government was elected in 2010 and started reducing NHS funding, it has been mental health services that have borne the brunt of the cuts with £600 million cut from their budgets between 2011 and 2016, while area health authorities attempted to prop up mainstream health services. At the same time funding for social care was also being slashed. The crisis is particularly severe in children’s mental health services, where children with eating disorders may be sent for treatment hundreds of miles from their homes and families.
It is important that we attempt to understand what is happening in this field, why it happened and what can be done, which is why the title of this book is so appealing. In Politics of the Mind: Marxism and Mental Distress Iain Ferguson explores in detail how mental health problems are caused by capitalism and austerity. He provides a wide range of useful facts about the extent of mental distress, the history of thinking on the issue and the various forms of treatment.
Ferguson, whose academic and professional background lies in social work, counterposes a social model of mental health, that recognises the impact of the social environment, employment, class and the role of talking therapies, against a medical model that focuses on malfunctions of the brain and the importance of medication. The social model recognises that austerity can have a damaging impact on people’s well-being which a medical model does not. Ferguson explains why, recently, there has been such an increase in the numbers of people with mental illnesses.
Ferguson’s use of language reflects his opposition to the medical model. He argues that to refer to “mental illness” is unacceptable because of the association with biochemical or genetic approaches and prefers the term “mental distress”.
His analysis is predominantly Marxist, and is also influenced by the anti-psychiatry, and critical and radical psychology movements which reject medical or biological understandings. He is opposed to the increasing use of antidepressants which he sees as: “one indicator of the dominance of an ideology and approach (reinforced since 2010 in the UK by huge cuts to community-based alternatives) that sees depression, along with a wide spectrum of conditions ranging from anxiety to schizophrenia, as illnesses requiring a medicalised response”.1
The medicalised approach to which Ferguson refers started in the 19th century and he documents its history well in this book. His strong opposition to this model is exemplified by his suggestion that the mental distress of a person with depression would be alleviated by knowing that it was austerity that was causing such problems in their life. Of course, the poverty, unemployment or other stress caused by austerity can be a significant factor in depression; but, unfortunately, resolution of the problem is not this simple.
A recent international study on the use of antidepressants confirms Ferguson’s claim about the impact of cuts on mental health treatments and the increased use of antidepressants:
Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions.2
But their findings also show that antidepressants are more effective than placebos for participants with major depressive disorders. So we should not write them off.
At least 0.1 percent of the UK population suffer from psychosis. They also need treatment with medication to alleviate some of the symptoms, although in such cases medication is still problematic in terms of side-effects and efficacy. Surely what people suffering from mental health trauma require is appropriate medication and psychological support. But, as Ferguson says, the ultimate problems for many, but by no means all, sufferers are the social conditions under which we live. Thus while antidepressants may help to alleviate depressive symptoms, the initial causes are outside the control of mental health professionals.
In addition, not all people experiencing similar social or emotional circumstances react in the same way. Some have a greater vulnerability to mental trauma than others. This difference in response has been shown to have its roots in genetic variation. A 2013 study by the Cross-Disorder Group of the Psychiatric Genomics Consortium found that the five most common major mental illnesses—bipolar disorder, schizophrenia, depression, ADHD and autism—were associated with common inherited genetic variations.3 This useful finding should be helpful to Marxists in understanding the complexity of mental distress.
There has been a recent increase in the number of young people suffering from cannabis-related psychosis. According to the Royal College of Psychiatrists: “research over the last 10 years has suggested that [cannabis use] can have serious consequences for people, such as the development of an enduring psychotic illness, particularly in those who are genetically vulnerable”.4 These examples explain how their genetic make-up can result in some people having more negative mental reactions than others, which should not be dismissed for being a biological explanation.
We also need to account for other, biologically-related, causes of mental distress, such as the menopause for women. A recent study conducted by ComRes for the BBC found that 48 percent of women who had experienced the menopause thought that it had a negative impact on their mental health.5 Similarly, there are also significant levels of severe mental distress for postnatal women.
A model of mental health needs to relate the biological brain to consciousness, which stems from biological brain function, and to the body, as well as social experience. Because bodily health is related to mental health, exercise is of benefit to a wide range of mental health problems including dementia, schizophrenia and drug and alcohol dependence.6
Clearly Ferguson is concerned to show the impact of social factors on mental health, which he achieves in fascinating detail, but the polarisation between the medical and social models is problematic. We should not dismiss a biological account in order to show the predominance of social factors as causes of mental distress. A Marxist account should really address both a biological and a social model.
The Russian psychologist Lev Vygotsky elucidates this position. With the recent publication of Vygotsky’s notebooks we can follow the process that he used in revolutionary Moscow in 1926 to work out a new Marxist psychology in response to the then popular stimulus-response theories of Ivan Pavlov. Vygotsky clearly distinguishes between the biological brain and the mind: “Mind is the perception of intracorporeal processes, just like we perceive the external world”.7 Our mind is our consciousness, whereas the brain is the physical organ: “The question of the mirror. The table is to the reflection of the table as being is to consciousness. But the reflection of the table is to the refracted beams as consciousness is to physiology, the brain”.8 And further: “The unconscious is biological; the conscious, social; the vivid cooperation of these two principles is the person”.9
Vygotsky proceeds to show how we can deploy the theory of dialectical materialism in understanding this relationship. Dialectical materialism, he says, relates to abstract theory. He argues that we need a “special theory” to apply the principles of dialectical materialism to psychology, and biology and sociology:
It suffices to imagine Marx operating with the general principles and categories of dialectics, like quantity-quality, the triad, the universal connection, the knot [of contradictions], leap, etc—without the abstract—and historical categories of value, class, commodity, capital, interest, production forces, base, superstructure, etc—to see the whole monstrous absurdity of the assumption that it is possible to create any Marxist science while bypassing Das Kapital. Psychology is in need of its own Das Kapital—its own concepts of class, base, value, etc—in which it might express, describe and study its object.10
So when we are looking at mental health issues we need to be aware of the history of the problem, of the person, the social and cultural context, etc. We need to apply historical materialism to concrete phenomena. This also applies to our understanding of the biological brain because it is not an abstract entity. The functioning of our brains is affected by our experiences. So negative experiences, such as those caused by the impact of austerity, neglect or physical factors can cause malfunctions and poor mental health.
If we discard theories of the biology of our brains, or the necessity of medication for some people with mental health issues, we fail to address fully the challenges in the treatment of mental illness, which requires a holistic approach—one that is socialist, materialist, dialectical and historical. We should include in this analysis the current paucity of medical treatment where, as in the asylums of the last century that Ferguson describes so well, inpatients are incarcerated, often with few therapies and treatments. We should include the inadequacy and massive overpricing of the capitalist pharmaceutical industry.
We can have a Marxist account of mental distress, and we should be able to call it mental illness without losing our commitment to understanding the impact of cruel capitalist governments on the mental health of us all and in particular on the most vulnerable.
Ferguson discusses the fightback in the mental health sector, mainly through service user groups. The failure of health unions to take industrial action over the recent mental health cuts, which affect mental health workers as well as service users, needs far more attention.
We need to incorporate the medical into the social models because in our world a medical intervention is a crucial part of a therapeutic mental health programme. As I have argued, we need a better funded and more integrated mental health service, with social workers having some medical expertise and mental health nursing staff knowing more about the devastating impact and effective treatments for social distress on service users’ lives. But above all we need a society that fully funds its NHS to meet all the physical and mental health needs of its people, and a government that is committed to health and welfare rather than lining the pockets of the rich.
Shirley Franklin is a health campaigner and is chair of Defend the Whittington Hospital Coalition.
Notes
1 Ferguson, 2017, p26.
2 Cipriani and others, 2018, p1.
3 Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013.
4 Royal College of Psychiatrists, 2017.
5 ComRes, 2018.
6 Faulkner, and Taylor, 2006.
7 Vygotsky, 2018, p77.
8 Vygotsky, 2018, p90.
9 Vygotsky, 2018, p80.
10 Vygotsky, 1987.
References