To challenge the notion that economic inequalities causing status anxiety are the only drivers of mental health problems within capitalism I would like to use a personal example and then broaden that out to include a more generalised view of psychotic disorders that go beyond the more common mental health conditions of anxiety and depression.
From late teens onwards I suffered a mental health condition that left me for many years in a fearfully withdrawn state. Later out of curiosity when I was less confused and disintegrated I decided to request the medical records from the time I saw psychiatrists (approx 1969-72).and the short time I spent in a psychiatric hospital. Apart from a suicide attempt (cry for help), guilt about being a homosexual and electric shock treatment to stop me from being one there was some controversy over what was actually wrong with me. After many interviews the symptoms were plain to see:
- Neither desires nor enjoys close relationships, including being a part of a family
- Almost always chooses solitary activities
- Has little, if any, interest in having sexual experiences with another person
- Takes pleasure in few, if any, activities
- Lacks close friends or confidants other than first-degree relatives
- Appears indifferent to the praise or criticism of others
- Shows emotional coldness, detachment, or flattened affectivity
This is in fact a description of what is usually defined as a schizoid personality disorder which pretty much matches the state I was in.
From the records it looks like the good doctors eventually diagnosed the possibility of 'incipient schizophrenia' and shoved me on a course of anti-psychotic drugs which reduced me from an extremely withdrawn state to a zombie. Ironic, given R D Laing and other 'existentialist' psychiatrists were in vogue at the time and were advocating drug-free therapies.
Rejecting the notion that mental illness was either genetic or neurological in origin they exposed the 'bourgeois' nuclear family to scrutiny in an attempt to discover the social causation of psychotic disorders especially schizophrenia. Clearly to treat patients with mental disorders in a more humane and less clinical way was their approach while rejecting the notion of the 'sick' individual. Not quite Marxist, but pushing in that direction.
Todd Hamer states that there is much emphasis in the book he has reviewed on the resurfacing in capitalism of long dead primal psychology domination-submission structures practiced by our Simian ancestors. These take the modern shape of higher income = higher status whereas lower income = lower status, engendering feelings of subordination and less social worth, submission to the dominant power, behavioural deactivation, depression and despair. Coupled with this is the addictive behaviour of conspicuous consumption, gambling and drugs to replace people with dead objects to compensate for inferior status.
Narcissism, the tendency towards exaggerating "illusory superiority", acts as a hedge against status anxiety in the "sharp end of struggle against self-doubt and a sense of inferiority"; and coupled to this is the discovery that the higher income earned increases the likelihood of anti-social behaviour. It's unclear in this article whether or not the Dominance/Submission, Superior/Inferior positions strictly correlate to class status as in Capitalist/Ruling class against a subordinate and exploited Working Class.
Much of what the review reveals about the authors' findings are plausible and laudable in uncovering certain aspects of mental health disorders that are widespread in capitalist society such as anxiety and depression and their causal connections. However I don't believe this is the whole story in simply attributing economic/status inequalities as the bedrock of those disorders. There are other 'ideological' factors that come into play.
That is why I used myself as an example to begin with though it is a moot point whether or not it is the best approach to move from the particular to the general. However it became clear to me when the fog of misery had cleared that the route cause of the 'psychotic' disorder I had fallen into was double-edged.
Growing up in a working class family with expectations of bourgeois normality and masculinity I was crippled by the fear of being discovered a sexual pervert coupled with an aversion to making any form of sexual contact with other males. It didn't help that one of my sisters was a lesbian and one of my brothers was gay. Hence compounded secretiveness under a domineering older brother who acted like a controlling patriarch in place of an absent father added to the frigid zone of cold deception, evasion and alienation.
The point I am making here is a simple one. Had we been living in a society that was more accepting of homosexuality none of this mental disruption and social dislocation would have happened. In other words ideological oppression in the shape of bourgeois expectations of normality played the major part here rather than any considerations about depression or anxiety arising from Income inequality/status.
There are many other cases cited by Laing and others of people considered to be 'mad' because they do not conform to the social role or emotional route assigned to them by bourgeois convention. Confusion may arise and drive mostly adolescent family members from the twisted and contradictory parental signals on how to live a normal, respectabel life. This could range from the woman who found marriage unsatisfactory because her husband did not measure up to marital expectations of love and affection that he promised her to the child who defied his parents for simply not doing their bidding as a 'good' child should.
My own non-conformity to bourgeois norms were apparent in some of the findings of the MMPI test for psychological disorders. Apart from establishing how miserable I was (self-evident) these included the very unmasculine traits of having a "basic interest pattern in the direction of the opposite sex. He is tender minded and nonaggressive, preferring poetry to sporting activities." Add to this the fact that I was "imaginative, creative, unconventional and an individualist" and capable of 'unusual thoughts and sometimes preoccupied with abstract ideas' you have a shopping list of forbidden fruit disallowed in a capitalist/bourgeois system or at the very least frowned upon.
I realise this is a review of a review but the contents of it prompted me to challenge the narrow, economistic view of mental illness. Although this is correct in many respects it doesn't really deal with wider aspects of oppression especially with the burgeoning prevalence of mental illness among Women, BAME and LGBT+ people who live in a hostile bourgeois world misogyny, racism and homophobia.