I’ve been wanting to write on here about neoliberalism for while. This post should most likely be preceded by a post devoted solely to neoliberalism, as a concept: where it comes from, what it entails, how it shapes our lives and worldviews.
But this particular post feels more pressing. Maybe it will even help clarify things for me later when I try to write other posts about neoliberalism.
I want to talk about mental health. It needs to be talked about in a different way than the mainstream tends to talk about it, and I want to attempt that, aided by against-the-stream or on-the-edges-of-the-stream perspectives from those I’ve read, those I know personally, those who have spoken to me and others about it.
Mental health is something that most people would rather put on the backburner as far as topics of conversation go. Mental illness is one that most people would rather avoid altogether. It is, admittedly, uncomfortable for speakers and listeners, those who have been diagnosed or treated for it, those who haven’t but feel or fear that they should be, and those who never have and never wish to be.
I wonder what this says, if anything, about the sorts of people who end up in fields and disciplines connected to the study and treatment of mental illness. Are they more compassionate, maybe? Trying to do people and society a favor? Are they ‘atypical’, themselves, perhaps trying to understand their own behavior or suffering? Are they just morbidly curious? (Friends and relations of mine who work in such fields, know that whatever we agree or disagree upon, I am not passing a judgment, but rather posing some earnest questions about the nature of these fields– if anything from a cultural, not moral, position of questioning.)
Whatever their motivations, there is frequently a common thread running through mainstream study, prevention, and treatment of mental illness. This might be hinted at by the very term ‘mental illness’. If it is an illness, it arises within a single person; it is an individual, not collective phenomenon. The same ‘illness’– schizophrenia, OCD, or manic depression, for instance– can present in many individuals, but it is nevertheless an affliction of individuals, not of society. As such, it must be studied, treated, and prevented at the level of the individual.
I recently discovered that there is a thing called dermatillomania— a ‘condition’, I suppose, also called Skin-Picking Disorder (SPD)**. People ‘afflicted’ with this condition pick at their skin: face, arms, legs, backs, scalp. Lips. Cuticles. It is cataloged in the DSM-V under Obsessive Compulsive Disorder (OCD). Those with a related condition, trichotillomania***, pull out their hair, strand by strand. Eyelashes. Eyebrows. These disorders are also considered to be Body-Focused Repetitive Behaviors (BFRBs), and is sometimes seen as a symptom or manifestation of Body Dysmorphic Disorder (BDD).
If you followed any of the above links, you may have been struck by a commonality among several of the treatments offered: Cognitive Behavioral Therapy (CBT), Habit-Reversal Training (HRT), and Mindfulness training and practices are by and large focused entirely on the individual. They encourage patients to think about what they can do to change their environments, their routines, themselves in order to change their ‘habits’. Habits which, while they may be harmful in various ways to that individual, are most like to disturb, embarrass or repulse others– that is, society.
I want to preface the rest of this by saying that I do not believe that we as individuals should not in some way be responsible for our own mental health, treatment or improvement of well-being. To the contrary, I think that such participation can be an empowering and transformative experience. However, we should note a few disturbing observations about this schema.
To begin with, such treatments begin from the presumption that illness like dermatillomania are problems of the individual: that is, they are disorders of single and separate minds. For instance, we might acknowledge that two different people who are each suffering from schizophrenia are experiencing a similar phenomenon, but we wouldn’t suggest that the experiences of those two individuals are in any way correlated– this person is not suffering from schizophrenia because of that person. They might be suffering from schizophrenia due to similar psychologies or circumstances, but this person’s illness is not the direct cause of that person’s illness. As such, being an illness of an individual person, it is up to that individual, or up to us on behalf of that individual, to take some measures to treat it. In any case, it’s the individual that requires treatment.
Now, in all fairness, many people who work on treatments for mental illness acknowledge that it is often the product of exterior factors or circumstances. A person close to you dying might cause severe depression, intimate partner violence might produce anxiety attacks, wartime violence and near-death experiences can cause PTSD. There is also a recognition that many circumstances cannot be changed: we can’t reverse the loss of a loved one, domestic violence can be difficult or impossible to escape, the violence of war may reside in the mind long after the war ends. Keeping this in mind, let’s look again at illnesses like schizophrenia, manic depression, OCD, borderline personality disorder.
Is it possible that the majority of responsibility for mental illness should rest on our sociocultural surroundings? What if, instead of beginning with the individual, we began with society as the place from where illness arises? What if we assumed that it is possible that society– the sociocultural structures by which we are all bound, though in different ways– needs to change in order to ‘cure’ mental illness, not the individual? I’m not suggesting that all mental illness could be solved merely by finding the most ideal sociocultural circumstances, but it isn’t a coincidence that some societies have higher rates of certain types of mental illness and suicide than others; varying societal factors must have a major impact on definition, prevention, and treatment of mental illness. I’m quite ignorant here, and many posts could be devoted solely to this topic, but among ‘modern’, ‘industrialized’, and ‘developed’ countries, there has come to be a very particular way of approaching mental illness, and that is by focusing on the level of the individual.
I want to suggest that this a symptom of the neoliberal worldview. Neoliberalism focuses almost entirely on the level of the individual, even when talking about phenomena like globalization and transnationalism. States, corporations, and organizations are compartmentalized and atomized into individual units: citizens, consumers, employees, members. As members of a neoliberal culture, we see ourselves as part of organizations and states, but at the same time as self-contained, discreet Selves, part of and yet apart. Those who feel their identity to be part of a common or collective consciousness, who ‘lose’ their individuality, must have joined some sort of cult.
Mental illness is often talked about in terms of individual shortcoming, weakness, or failure. Those who kill themselves or attempt to are considered selfish, short-sighted, making excuses and lacking accountability or self-control. Solutions for individuals include being mindful, focused more the present, utilizing coping skills, and so forth. All of these are individual behavior and attitude changes; society is not required to change its behaviors or attitudes. Basically, by trying harder, individuals can work towards greater self-reliance, independence, responsibility and strength. The idea is, after all, that healthy individuals do not or should not have need of a therapist and do not excessively burden those close to them with the side effects of their mental illness or mental health needs. Well, and the therapist exists for that very purpose: to unburden those around us, which contributes to the notion that mental illness is a private and shameful matter. Yet the person who kills themselves for the very purpose of permanently unburdening those around them (and they are likely thinking of the individuals whom they love, not their school or company or country) is considered selfish. We need to have personal accountability to ourselves and others regarding our mental well-being– society is not accountable to us. As such, society should be right to fear, berate and institutionalize the mentally ill individual. Music, TV shows and movies often reflect neoliberal ideals, perhaps unconsciously and unselfcritically.
Briefly returning to dermatillomania: the websites referenced above readily admit that researchers are unsure of the causes of dermatillomania. In spite of this, treatments are still focused upon the individual. Why should this be, if we can’t even be sure the individual is necessarily able to stop these behaviors?
I want us to thing about new and different ways of looking at the treatment of individuals with mental illness. Is it so outrageous to imagine accommodating certain aspects of mental illness? Or better yet, to change sociocultural structures that might be catalyzing mental illness in the first place?
More thoughts to come… In the meantime, what are yours?
**I am wary of any group (bureaucratic agencies, NGOs, academic disciplines, whoever) who are overly fond of acronyms. Fuck, acronyms are annoying.
***How interesting, the insertion of “non-cosmetic” into their definition.