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Defining a Social Crisis: Intersections Between Mental Illness, Capitalism and Disability

The field of disability studies has frequently embraced the application of intersectional approaches towards defining body and mental disabilities. Through the various attempts to delineate a framework that can define disability as such, a myriad of contentions have come about in regards to the criteria that various thinkers have proposed. Such examples include the more classical often criticized medical model and the more accepted social model that has been the subject of discussion in contemporary debates. Other ways of defining disability under a more critical framework have been proposed by thinkers such as Elizabeth Barnes1. Given these frameworks, how can mental illness be defined as a disability? By answering this question, another question arises: how can depression and mental illness that are symptomatic of many social factors—including neoliberal capitalism—be interpreted and conceptualized in relation to disability?2 Accounting economic, environmental, social and political factors therefore becomes a crucial component in influencing what should be considered as disability. In this essay, I will argue for putting social considerations at the forefront for challenging how mental illness is framed, normalized and medicalized under capitalism; and how such framing fundamentally transforms the way certain concepts like ‘care’ and ‘treatment’ are understood and expressed in society concretely. Secondarily, I will also raise the question of whether mental illness should or should not be considered a disability or not, while also cautioning the framing of mental illness as a disability in ways that might aid the hegemony of capitalism.

The marriage between capitalism and mental illness are undoubtedly to many societies at present where capitalism has become the manifested economic paradigm. Although the mechanisms between capitalism and mental illness are still not fully understood on a casual basis, many factors do point to a very strong correlation between these two. This correlation can be explained by an association between economic crisis and mental illness3, how mental disorder is frequently associated with economic hardship and unemployment4, how these hardships are instigated through neoliberal austerity practices5 in conjunction to a long history of psychiatric medicalization and normalization of mental illness by government enterprises with the help of asylums, clinics, along with a multiplicity of policies and incentives that have welcomed deregulation of these enterprises6. We are reminded of Mark Fisher who is himself a victim to depression as he took his own life on January 13th, 2017. As a cultural critic who wrote extensively about his own experience of living with depression under capitalism, in Capitalist Realism he elaborates on how the “ruling ontology” of neoliberal capitalism rejects mental illness as a socially caused phenomenon7. This tendency can be generally described as a process of naturalizing mental illness under this hegemonic economic discourse. The formulation of mental illness as a “chemico-biological” factor that focuses on defining how it is instantiated rather than how it is caused—while also atomistically individualizing subjects suffering from mental illness and depression—acts as a catalyst for perpetuating an ill-conceived discourse of mental illness under capitalism. Such discourse, for example, provides the conditions under which the multi-billion pharma industry8 can provide cures and remedies for restoring the functioning of mentally ill individuals—as individuals, while avoiding addressing the social conditions that also be the cause of these illnesses. The framing of mental illness as an individual and subjective problem, while reducing the focus on social and intersubjective dimensions as a potential cause for this subjective problem, has become the predominant form of framing mentaller illness under capitalism. To this point, Nancy Fraser adds that capitalism does not just generate a single monolithic, all-pervasive logic and ontology, but rather, “a determinate plurality of distinct but inter-related social ontologies”9. She points out how production in capitalism increasingly relies not only on production of commodities, but also in social reproduction which serves as a crucial component in sustaining the reproduction of the former:

One is the epistemic shift from production to social reproduction—the forms of provisioning, caregiving and interaction that produce and maintain social bonds. Variously called ‘care’, ‘affective labour’ or ‘subjectivation’, this activity forms capitalism’s human subjects, sustaining them as embodied natural beings, while also constituting them as social beings, forming their habitus and the socio-ethical substance, or Sittlichkeit, in which they move. Central here is the work of socializing the young, building communities, producing and reproducing the shared meanings, affective dispositions and horizons of value that underpin social cooperation.10

A crucial component in the advent of this social reproduction also consists of the way subjects are compelled to comport themselves if they require mental ‘care’ while also how such mental ‘care’ is prescribed. As Mark Fisher points out, the totality of pathologizations enacted by juridical, economic, medical and social institutions, etc.—that operate under a broader umbrella terms ‘ideology’ and ‘ontology’—play a crucial role in naturalizing the state of affairs that would otherwise be considered abnormal, a symptom of a contradiction within society, or even a social crisis11.

Mental Illness therefore requires a repolitization that puts this problem to the forefront of social, economic, intersubjective and political considerations. Here, the political aspect that can be put in consideration might lapse into colonial and post-colonial discourse that originates in the work of Franz Fanon who outlines the way colonialism constructs a particular, hegemonic colonial subjectivity. Although varying in a myriad of ways from colonial contexts, a similar construction of mental illness, sickness and disability under the present hegemonic discourse of neoliberalism can be delineated nevertheless. If at least one such brief connection can be made, it is precisely the relation between the construction of colonial subjectivity and the construction of sickness and illness, whether bodily or mental. In disability studies, this term is coined as ‘able-bodiness’, but an equivalent construction of mental ability and normality also exists12. What the construction of able-bodiness shows, is how the definition ’ability’ and ‘wellness’ also necessarily defines its antonymous term that which must be cured and fixed as an inherent logic of constructing this very normality and ability. When these contrary terms are considered in their totality, we get a reproduced social ontology: in colonialism, this ontology consists of the colonizer and the colonized; in the construction of mental disability under capitalism, it consists of constructing the abled and disabled. Both of these ontologies have one similarity in common, they not only perpetuate social reproduction, but social production as well—where one’s state of normality is restored for the sole purpose of having him/her maintain their function as a laboring/working individual. It is precisely in this way that the very definition of terms like ‘care’ become subverted and subsumed under what Fraser refers to as the ‘Sittlichkeit’, where terms like ‘care’ are accounted mostly as means of restoring the productive capacities of an individual. This subversion of care through the use of able-bodied constructs, is put by Johanna Hedva in their own words:

“Sickness” as we speak of it today is a capitalist construct, as is its perceived binary opposite, “wellness.” The “well” person is the person well enough to go to work. The “sick” person is the one who can’t. What is so destructive about conceiving of wellness as the default, as the standard mode of existence, is that it invents illness as temporary. When being sick is an abhorrence to the norm, it allows us to conceive of care and support in the same way. Care, in this configuration, is only required sometimes. When sickness is temporary, care is not normal.13 (Emphasis my own)

The very way in which ideas like ‘care’ become redefined under neoliberalism, point to the type of austerity that it instigates. These redefinitions can be generally summed up as an inherent aspect of transformations in the governance of the liberal state over the past century, which serve as a catalyst for the increasing rise of the so called ‘new public management’. One of many emphasis manifested under this management, is pharmacological treatment as a substitute to residential care and various other forms of transformations that are generally attributed to the neoliberlization of the public sphere involving the outsourcing of services previously (or elsewhere) provided by either by the government directly14, or was an inherent aspect of communal care. The moral justification for the advancement of these transformations can be summed up by thinkers such as John Stuart Mill who argued for “balance between respect for individual autonomy of action and compassionate support (or even ‘intervention’) to support human flourishing”15. In addition to these moral suppositions that underline the modern liberal state, there is also an intersection that consists of the privatization of the public sphere as a method of de-regulating, commodifying, valorizing, capitalizing and financializing an increasing part of the social sphere; countries like Britain and Australia among others, as an example, have opened up the grounds in which private, for-profit, lunacy retreats can be managed by private entities with some minor regulation imposed by the state16. This explains why various forms of initiatives such as deinstitutionalization, mainstreaming of mental health, and organization of community-based care, receive bad press from their stakeholders; while the actually concerns about the mentally ill is frequently accompanied with the interests of capital17. Overall, these initiatives can be equated to what Fisher refers to above as a construction of a ‘neoliberal ontology’; where all spheres of mental illness service adopt a market narrative; where all interactions among individuals must be reduced to atomized contracted transactions. With these themes depicting the way mental illness is constructed under neoliberalism, we proceed to a elaboration of the stakes behind the question of including mental illness as a disability while also elaborating how mental illnesses is framed within the field of disability studies. Before proceeding however, a passage from Albert Camus’s The Myth of Sispyphus could serve as a philosophic interlude that alludes not only to the construction and pathologization of mental illness, but also a comical refutation of this very construction. As Camus recounts:

You know the story of the crazy man who was fishing in a bathtub. A doctor with ideas as to psychiatric treatments asked him “if they were biting,” to which he received the harsh reply: “Of course not, you fool, since this is a bathtub.”18

What this anecdote demonstrates, is perhaps the underlying set of pre-assumptions that the psychiatrist has towards the patient, which in turn, are proved to be unfounded. In this specific instance, it was the psychiatrist who presupposed that the patient was mentally impaired to a point where he thought the patient was not aware of the fact that it is impossible to catch a fish in a bathtub. This however, turned out not be the case; the patient was fully aware of the manifested absurdity of his own acts; the fool therefore turned out to be the psychiatrist, not the patient. In this situation, while observing the patient, the psychiatrist quite confidently sees the possible diagnosis for his patient; he already sees how he can understand and pathologize the subjectivity of his patient. Thus, the subjectivity of the patient is reduced to these very narrow psychiatric conceptions and pre-assumptions. Just like a physicist, the psychiatrist already has a decent bag of knowledge and methodologies that serve as a foundation on which he lays out a diagnose that classifies the mental abnormalities of his patient. The patient for the psychiatrist is an object of knowledge, just like an experiment is to a physicist; they both work within certain frameworks consisting of presuppositions and classifications about their subject-matter, whose frameworks of knowledge fundamentally disregard whether the object of inquiry is the psychology of a living human brain or a particle accelerator.

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With an outline of various ways by which mental illness is constructed under neoliberal capitalism along with the way in which pathologization of illness always risks of becoming reductive, we proceed to the question of disability. Given that depression is one of the causes of these social relations, how would one contextualize depression and other derivatives of mental illness in relation to disability? Here, the two disability that can be discussed, is the medical model and the social model. In Including All of Our Lives, Liz Crow outlines the distinction of the medical model, and the social model that seek to interpret disability and impairment in diverging ways.19 Influenced by Victorian institutions and practices developed throughout 18th and 19th centuries, the medical model focuses on pathologizing the individual, defining disability based on a functional prescription of a body’s limitations in an environment. The type of solutions that frequently arise based on the individualistic interpretation of impairment inherent in the medical model, is to provide some form of ‘fix’ or a ‘solution’ for overcoming a disability. The social model on the other hand, attempts to counteract the medical models exclusionary emphasis on the individual by shifting its focus from impairment onto disability through an account of the social, environmental, and attitudinal barriers, rather than lack of intrinsic ability20. However, this emphasis on the environmental circumstances to define disability at the same time rejects the notion of impairment being something potentially problematic, which in turn, directs the social model to emphasize on discrimination and exclusion as the most significant obstacles to a disabled person’s quality of living21. As a solution to the incommensurable dichotomy between the social model and the medical model, Crow offers an integration of different opposites: disability and impairment, external and internal—but an integration that maintains an emphasis that a “change in one is not necessarily linked to change in the other”22. Here, a definition between disability and impairment is also crucial, as Mulvany sums up through the words of Barnes and Oliver:

[Disability is] the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from the mainstream of social. Impairment, on the other hand, refers to some bodily defect, usually constituting ‘a medically classified condition’).

Since one of the tendencies in neoliberalism is to pathologize mental illness as something that is naturalized and ‘chemico-biologically’ derived, then the classification of mental illness as an impairment immediately raises some skepticism. As of Crow outlines also outlines, disability is usually defined based on certain environmental and pathological barriers, it is frequently subject to the rhetoric of ‘fixing’ and in need of solutions, while completely omitting the subjective experience out of the formula. However, Crow also states that fixing all social, environmental factors is not enough since individual problem would still remain, as Crow states “personal struggle will remain even when disabling barriers no longer exist”23.

The definition of mental illness as a disability raises a contention among many. Some argue that a definition of a disability (whether bodily or mental) should focus on the common social oppression which people with disabilities face, and on their need to unite politically to fight this oppression24. In the case of neoliberalism, this would entail individuals whose mental illness is perpetuated by this form of social oppression to unite politically, while at the same time, challenging the hegemony of a discourse that naturalizes, medicalizes and normalizes what in actuality might turn out to be a social crisis. Examples of thinkers who thought about the way individuals with mental illnesses (schizophrenia in particular) can constitute a political force that challenges the hegemony of capitalism, is explicated in works such in Anti-Oedipus by Deleuze and Guattari25. Other thinkers however argue that disability must be defined based on an ’monolithic experience’ that ignores differences in class, gender, race and ethnicity, sexual orientation and age.26 The later approach however, raises skepticism precisely due to how similar this homogeneous definition is to the way in which the neoliberal discourse attempts to reduce mental illness to very narrow set of definitions that completely obfuscate other crucial social factors that cause mental illness. By omitting differences in class, gender, race, ethnicity, sexual orientation and age, one risks lapsing back to an individualized account of mental illness that strips away important social, environmental and economic circumstances of a mentally ill individual. Given that one of the main questions that this essay attempts to answer is whether mental illness can be labeled as a disability without serving as a catalyst for perpetuating and concealing a mental crisis that exists under neoliberalism, then a few concerns were raised above.

One of the ways to respond to the critique and risks regarding the definition of disability, is regarding the social model of disability which offers the methodologies for conceptualizing disability based on environmental and socio-economic factors. Mulvany poses a question as to how should one approach this topic, must mental disorder be labeled as a disability, as an impairment or as an illness?27 Mulvany suggests that in order to answer this question, a theory of disability must take the social approach which transforms the emphasis that regards social factors, including economic circumstances, discriminations and exclusions. Another important aspect in this approach, is an analysis of people’s experiences of impairment and disability, which could enhance theoretical understandings of the nature and impact of social barriers for people with disabilities and how these barriers effect individuals with various backgrounds in varying degrees.

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  1. Barnes, Elizabeth; The Minority Body (Oxford: Oxford University Press, 2016). 

  2. If naturalization of body abnormalities was a predominant object of critique that is expounded in the works of figures like Michel Foucault, the naturalization of mental illness has become the predominant form of pathologization in the discourse of post-modernity and neoliberalism. While a Marxian account, could give us a more concrete view on how these pathologizations effect society on a concrete basis. 

  3. Antti Uutela, “Economic crisis and mental health”, National Institute for Health and Welfare THL, 2010, p.1. <DOI: 10.1097/YCO.0b013e328336657d> 

  4. Julie Mulvany, “Disability, impairment or illness? The relevance of the social model of disability to the study of mental disorder”,Sociology of Health & Illness (Vol. 22 No. 5 2000). p. 583. 

  5. Carney, p. 102. 

  6. Bradley Lewis, ed. Lennard Davis; “A Mad Fight: Psychiatry and Disability Activism”, The Disability Studies Reader. Routledge (Taylor & Francis Group, 2017) 

  7. Mark Fisher, Capitalist Realism: Is There No Alternative? (Winchester: Zero Books, 2009), p. 37. 

  8. See F. Palazzi, “Choose Your Pill. Operations of Capital, Psychiatry, and the Construction of Gender”, Public Seminar, 27 June 2018 where he mentions Paul B. Preciado who provides us with the notion of the pharmacopornographic regime, where the application of various pharmaceutical remedies have become a new paradigm after World War II as a precursor to the present so called ‘pharma industry’. Further elaborations in regards to drugs such as Prozac have also been elaborated in J.M. Metzl, Prozac on the Couch. Prescribing Gender in the Era of Wonder Drugs (Durham: Duke University Press, 2003), chapter 3. 

  9. Nancy Fraser, “Behind Marx’s Hidden Abode: For an Expanded Conception of Capitalism”, New Left Review 86, (2014), p. 67 

  10. Nancy Fraser, “Behind Marx’s Hidden Abode: For an Expanded Conception of Capitalism”, New Left Review 86, (2014), pp. 61-2 

  11. Fisher, p. 16. 

  12. Source 

  13. Johanna Hedva, “Sick Woman Theory: Who Were Never Meant To Survive But Did”, Mask Magazine <http://www.maskmagazine.com/not-again/struggle/sick-woman-theory

  14. Terry Carney, “The mental health service crisis of neoliberalism — An antipodean perspective”, International Journal of Law and Psychiatry 31 (2008), pp. 101-2. 

  15. Ibid

  16. For Intersections between these private spheres and various state initiatives and other entities such as the American Psychiatric Association (APA) among others; see Lewis, A Made Fight: Psychiatry and Disability Activism

  17. Carney, p. 111. 

  18. Albert Camus, trans. Justin O’Brien; The Myth of Sisyphus and Other Essays (New York: Vintage Books, 1991), p. 129 

  19. Liz Crow, Ed. J Morris; Encounters with Strangers: Feminism and Disability (London: Women’s Press, 1996). 

  20. Liz Crow, p.3. 

  21. Liz Crow, p.11. 

  22. Liz Crow, p.15. 

  23. Liz Crow, p.4. 

  24. Oliver, M. ; Understanding Disability: from Theory to Practice. (London: Macmillan, 1996). 

  25. Gilles Deleuze, Felix Guattari; Anti-Oedipus: Capitalism and Schizophrenia (New York: Penguin, 1977). 

  26. Mulvany 2000, p. 587. 

  27. Julie Mulvany, “Disability, impairment or illness? The relevance of the social model of disability to the study of mental disorder”,Sociology of Health & Illness (Vol. 22 No. 5 2000). pp. 582—601.