Half of all adults in the U.S. will develop at least one mental illness during their lifetime, with 45 million experiencing psychiatric disorders in any given year. Suicide rates are currently at a thirty-year high, substance abuse has become epidemic, and a new culture of online connectedness thinly masks a phenomenon of social isolation. From city to suburbia, virtually everyone has either suffered or knows someone who has.
Most instances of mental illness go untreated, owing to a combination of social stigma and lack of access to care. The more fortunate among us will be prescribed regular meetings with a therapist who promises to fix us and help us adjust ourselves to polite society, possibly with the aid of medication to correct our "chemical imbalances."
But with the symptoms so widespread in our population, we ought to ask: what if correcting ourselves is not enough? What if the problem runs much deeper: that distress, misery, and loneliness are woven into the very fabric of our social system? We have long known that our social conditions — everything from our physical environment, to socioeconomic background, to prevailing cultural beliefs — exert overwhelming influence over our psychological well-being. It's time, then, that we started to be precise about what exactly is at the root of the mental health crisis; it's time we identified this system by its name: capitalism.
An Anxious Society
At the heart of many mental health problems is a perceived lack of control over one's circumstances, or fear of external forces. According to Irish psychiatrist Peadar O'Grady,
The term 'anxiety' is used particularly when the threat is not immediate or is unclear, but it is fear by another name… Whether the particular mental illness does not involve major disorganization of thought or perception (traditionally called neurosis) or is severe with disorganization of thought or perception (psychosis) or brain functioning (Delirium and Dementia), fear is often a central component of suffering and distress.
In this light, the connections between political economy and mental illness become clear; what is capitalism, after all, if not a system that rests upon the great majority of the population living in constant fear and insecurity? For forty years, wages have been stagnant or falling for most households, while those who are fortunate enough to have a steady job typically work longer hours than the average medieval peasant. Sky-high rents push neighbors out of their homes, wrenching apart communities and putting people on the streets. Social media keeps us ever more connected online, while walling us off in the real world. Pressures and expectations set by corporate marketing departments degrade our self-image and induce eating disorders in teenagers. Public spaces are scarce and increasingly privatized, locking out those without the means to pay for the luxury of human interaction (how many places can you think of where you can sit down for an hour and chat with a friend, without buying something or paying a fee?).
The Psychology of Markets
Yet capitalism's reach extends much further than its economic effects; it also shapes our ideology and how we perceive our place in the world. Modern-day capitalism, with its unshakable faith in deregulated markets, privatization of the public sphere, and austerity budgets, has of course contributed to our financial misery, leading to mass hopelessness and anxiety. But far from being confined to economic policy, contemporary capitalism (often called "neoliberalism") also embodies a philosophical belief that self-interest and competition, not cooperation, should pervade every aspect of our lives. In short, our world is shaped in the image of the market. For those in distress, Margaret Thatcher's oft-cited mantra, "There is no such thing as society," sends the most disturbing possible message: "You're on your own."
The psychological toll of this market-extremist thinking is ubiquitous and measurable. A long line of social science research has shown that unemployed people are much more likely to become depressed; after all, under the reigning ideology, our self-worth is measured by our economic output. Moreover, since the market is (we are told) a level playing field, with no single actor appearing as the obvious coordinator, those who happen to be losers in this global scramble ostensibly have no one to blame but themselves. In such a world, it is extremely dangerous to fall below average — to be deemed inadequate, too lazy or incapable of pulling one's weight, dependent on government handouts, and ultimately a burden on society.
Most of us intuitively understand this game and its stakes, which is why we set out very methodically to climb the corporate ladder and keep our resumes in top shape. This careerist mentality also seeps into our social interactions, as we are constantly spiffing up our Facebooks, uploading perfectly saturated Instagrams, and flouting our wokeness in Twitter arguments, all to market ourselves and develop our personal and social brand. These are not the actions of a human being in their natural state, but rather a creature modeling itself after the capitalist firm, an institution bestowed with the legal mandate to relentlessly maximize profits — social, ethical, and environmental consequences be damned. The corporation checks off so many of the traits usually assessed for psychopathy — manipulativeness, shallow affect, lack of long-term goals, aversion to responsibility — that legal scholar Joel Bakan called it, in his book The Corporation, "a pathological institution." If we ever encountered a person who sought only to pursue self-interest, they would be regarded as psychopathic; yet increasingly, this is precisely what we are doing and becoming.
An Engine of Alienation
Beyond these direct threats to our material and psychological wellness, modernity also seems to be accompanied by an inescapable feeling of general emptiness, isolation, and lack of meaning, which so many existential philosophers and social theorists have attempted to capture and understand. Some, such as Durkheim, studied how religious communities (or lack thereof) contribute to suicidal tendencies. One historical figure too often omitted in contemporary discourse, however, is the young Karl Marx. In his "theory of alienation," developed in the Economic and Philosophic Manuscripts of 1844 and other texts, Marx showed that the meaninglessness and isolation of modern life is baked into capitalist economic relations.
To do this, Marx asked us to imagine the pre-industrial artisan — the shoemaker, the baker, the tailor — who worked not for a capitalist, but for themselves. Such an independent producer retained control over their work and the entire creative process, so that their product was something they could be proud of and see themselves in; moreover, they had the satisfaction of seeing their product go to immediate use, fulfilling a human need. "Our products," Marx concluded, "would be so many mirrors in which we saw reflected our essential nature." Labor was a point of joy, meaning, and human connectedness.
Not so under capitalism, when one toils in the factory or office for a wage. Here, the worker is a replaceable commodity who does what the boss demands; as a result, labor is used not as an outlet for creative self-expression, nor to fulfill the needs of our fellow human beings, but rather to produce a profit. The daily act of work serves as proof of our unfreedom rather than of our humanity; the very product that rolls off the production line appears as an object alien to us, rather than as a manifestation of our individuality. In Marx's words: "The activity of the worker is not his spontaneous activity. It belongs to another. It is a loss of his self."
The loss of meaning and agency at work — where we spend most of our waking hours — is a huge blow to the psyche in and of itself. However, the capitalist system generates alienation on an even grander scale. As social beings gifted with powerful mental faculties, we are naturally wired to cooperate and to create. But because capitalism forces us to fight over jobs and resources, we view each other not as collaborators and companions, but as competitors. In time, this system would come to dictate our social relations; now, in an era of competition and profit maximization, we see each other as objects — as means to our various ends, rather than multi-dimensional beings. Indeed, research done by social psychologists such as Tim Kasser have found that individuals who internalize "the materialistic ethos of corporate culture" exhibit "more anti-social activities" and "lower empathy." In short, the capitalist wage relation alienates us from our product, while the superstructure of the labor market alienates us from one another.
Reflecting on the present day, is this not precisely what has transpired? We hate our jobs and have little control over what we do — and often have no idea what purpose it serves anyway. Work feels draining rather than satisfying, because we understand that those hours do not belong to us; our lives begin when work ends. In the pittance of spare time we have left, we try to consume ever more stuff, hoping to satisfy our craving for ownership and expression. But alas, commodities don't provide lasting fulfillment; only genuine human interaction and authentic self-expression can. The solutions presented by capitalism inevitably fail to cure the malaise capitalism itself created.
Medicalizing the Psyche
What can be done about all this? Today, the severity of the mental health crisis is now widely recognized. There is an international movement comprising public health experts, social workers, and academics, who have set about very seriously and sentimentally to raise awareness of mental illness, to destigmatize the seeking of professional help, and to improve access to care.
Yet the contemporary medical reaction to this epidemic almost never asks the difficult but necessary questions: Why are people physically and emotionally isolated? Why do we feel such lack of control over our own destinies? Which structures in society give rise to these conditions?
Because it lacks a critique of the social systems at the heart of the crisis, the mental health community remains singularly focused on symptoms rather than causes, and ends up peddling palliatives, not cures. As anyone who has seen a psychotherapist knows, the premise is that the subject is "sick" and therefore needs to be fixed, whether by medication, adjustments in lifestyle, or ultimately changing one's mindset. In recent years, members of the psychiatry community have come out against the social ideology of the field, and especially of the dominant paradigms of therapy such as Cognitive Behavioral Therapy. As psychoanalyst Robert Fancher writes in Health and Suffering in America,
The basic norm of cognitive therapy is this: Except for how the patient thinks, everything is okay. Reality is not pathogenic. Just think straight and life can be good enough. A person should…convince herself of a generally optimistic view of how life works in this time and place — and confine her imagination to possibilities consistent with this. She should quell passions that would put her at odds with the status quo. She should not let her mind drift off into thoughts about life that might make her conclude that she…is unlikely to find fulfillment.
Once we have reduced this complex social phenomenon to the apolitical realm of individual medicine, it follows that the solution to the broader mental health epidemic is presented as merely public "awareness" and "destigmatization" — essentially efforts to funnel people into the therapy pipeline.
But as we have seen, mental distress arises in large part because of the discrepancy between human needs — connection, security, meaning — and the alienating social conditions offered by society. It is the plight of the initially sane person reacting to a mad world, to which the modern psychiatry industry would have us believe that the solution is to improve the individual, whether through therapy sessions or psycho-drugs. The late cultural theorist Mark Fisher summarized the situation thusly:
The privatisation of stress is a perfect capture system, elegant in its brutal efficiency. Capital makes the worker ill, and then multinational pharmaceutical companies sell them drugs to make them better. The social and political causation of distress is neatly sidestepped at the same time as discontent is individualised and interiorised.
Therapeutic Struggle
How can we go beyond mainstream psychiatry, and build a movement to advance mental health at the societal level? Today, there are slivers of hope: a growing awareness among psychiatrists that social and cultural norms influence mental health and diagnoses; psychology research that critically examines the effects of neoliberal policy and values; and renewed interest in worker cooperatives, which promote greater worker happiness. All of these directions should be explored, nurtured, and funded.
Ultimately, however, we will need to think bigger. Psychiatry, no matter how well-intentioned, is largely structured as a capitalist enterprise, and does not address the causes of the problem. Worker cooperatives, meanwhile, are still subject to the competitive dictates of the market. The present situation calls for a new, radical politics that de-commodifies as much as possible, including and especially human labor. In other words, in the end we must still confront and defeat capital, the cancer that poisoned modernity.
And there is no time to lose: part of the reason why fascism is on the rise across the West is because it gives people meaning, social cohesion, and a sense of purpose. This is of course a cohesion built around the exclusion of marginalized people, but it is a seductive offer that technocratic liberals are ill-equipped to confront. Fortunately on the socialist left, we have arguably the most powerful ideological tools available. It is curious and sublime, though perhaps not coincidental, that the very act of leftist politics is one of social healing, of solidarity and collective struggle — the very opposite of isolation and alienation. It is our task to bring this emancipatory language and action back into the political realm.
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