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Capitalism and Mental Health

by David Matthews
(Jan 01, 2019)
Topics: Capitalism , Health , Inequality , Political Economy
Places: Europe , Global , United Kingdom

Illustration by Andrzej Krauze (The Guardian, October 12, 2016).

DAVID MATTHEWS is a lecturer in sociology and social policy at Coleg Llandrillo,


Wales, and the leader of its degree program in health and social care.
A mental-health crisis is sweeping the globe. Recent estimates by the World Health
Organization suggest that more than three hundred million people suffer from
depression worldwide. Furthermore, twenty-three million are said to experience
symptoms of schizophrenia, while approximately eight hundred thousand individuals
commit suicide each year. Within the monopoly-capitalist nations, mental-health
1

disorders are the leading cause of life expectancy decline behind cardiovascular
disease and cancer. In the European Union, 27.0 percent of the adult population
2

between the ages of eighteen and sixty-five are said to have experienced mental-
health complications. Moreover, in England alone, the predominance of poor mental
3

health has gradually increased over the last two decades. The most recent National
Health Service Adult Psychiatric Morbidity Survey illustrates that in 2014, 17.5
percent of the population over the age of sixteen suffered from varying forms of
depression or anxiety, compared to 14.1 percent in 1993. Additionally, the number
of individuals whose experiences were severe enough to warrant intervention rose
from 6.9 percent to 9.3 percent. 4

In capitalist society, biological explanations dominate understandings of mental


health, infusing professional practice and public awareness. Emblematic of this is
the theory of chemical imbalances in the brain—focusing on the operation of
neurotransmitters such as serotonin and dopamine—which has gripped popular and
academic consciousness despite remaining largely unsupported. Moreover, 5

reflecting the popularity of genetic reductionism within the biological sciences, there
has been an effort to identify genetic abnormalities as another cause of mental-
health disorders. Nonetheless, explanations based on genomics have also failed to
6

generate conclusive evidence. While potentially offering illuminating insights into


7

poor mental well-being in specific cases, biological interpretations are far from
sufficient on their own. What is abundantly clear is the existence of significant social
patterns that elucidate the impossibility of reducing poor mental health to biological
determinism. 8

The intimate relationship between mental health and social conditions has largely
been obscured, with societal causes interpreted within a bio-medical framework and
shrouded with scientific terminology. Diagnoses frequently begin and end with the
individual, identifying bioessentialist causes at the expense of examining social
factors. However, the social, political, and economic organization of society must be
recognized as a significant contributor to people’s mental health, with certain social
structures being more advantageous to the emergence of mental well-being than
others. As the basis on which society’s superstructural formation is erected,
capitalism is a major determinant of poor mental health. As the Marxist professor of
social work and social policy Iain Ferguson has argued, “it is the economic and
political system under which we live—capitalism—which is responsible for the
enormously high levels of mental-health problems which we see in the world today.”
The alleviation of mental distress is only possible “in a society without exploitation
and oppression.” 9

In what follows, I briefly sketch the state of mental health in advanced capitalism,
using Britain as an example and utilizing the psychoanalytical framework of Marxist
Erich Fromm, which emphasizes that all humans have certain needs that must be
fulfilled in order to ensure optimal mental health. Supporting Ferguson’s assertion, I
argue that capitalism is crucial to determining the experience and prevalence of
mental well-being, as its operations are incompatible with true human need. This
sketch will include a depiction of the politically conscious movement of users of
mental-health services that has emerged in Britain in recent years to challenge
biological explanations of poor mental health and to call for locating inequality and
capitalism at the heart of the problem.

Mental Health and Monopoly Capitalism


In the final chapters of Monopoly Capital, Paul Baran and Paul Sweezy made explicit
the consequences of monopoly capitalism for psychological well-being, arguing that
the system fails “to provide the foundations of a society capable of promoting the
healthy and happy development of its members.” Exemplifying the widespread
10

irrationality of monopoly capitalism, they illustrated its degrading nature. It is only for
a fortunate minority that work can be considered pleasurable, while for the majority
it is a thoroughly unsatisfactory experience. Attempting to avoid work at all costs,
leisure frequently fails to offer any consolation, as it is also rendered meaningless.
Rather than being an opportunity to fulfill passions, Baran and Sweezy argued that
leisure has become largely synonymous with idleness. The desire to do nothing is
reflected in popular culture, with books, television, and films inducing a state of
passive enjoyment rather than demanding intellectual energies. The purpose of
11

both work and leisure, they claimed, largely coalesces around increasing
consumption. No longer consumed for their use, consumer goods have become
established markers of social prestige, with consumption as a means to express an
individual’s social position. Consumerism, however, ultimately breeds dissatisfaction
as the desire to substitute old products for new ones turns maintaining one’s position
in society into a relentless pursuit of an unobtainable standard. “While fulfilling the
basic needs of survival,” Baran and Sweezy argued, both work and consumption
“increasingly lose their inner content and meaning.” The result is a society
12

characterized by emptiness and degradation. With little likelihood of the working


class instigating revolutionary action, the potential reality is a continuation of the
“present process of decay, with the contradictions between the compulsions of the
system and the elementary needs of human nature becoming ever more
insupportable,” resulting in “the spread of increasingly severe psychic disorders.” In 13

the current era of monopoly capitalism, this contradiction remains as salient as ever.
Modern monopoly-capitalist society continues to be characterized by an
incompatibility between, on the one hand, capitalism’s ruthless pursuit of profit and,
on the other, the essential needs of people. As a result, the conditions required for
optimum mental health are violently undermined, with monopoly-capitalist society
plagued by neuroses and more severe mental-health problems.
Erich Fromm: Mental Health and Human Nature
Baran and Sweezy’s understanding of the relationship between monopoly capitalism
and the individual was significantly influenced by psychoanalysis. For one, they
made references to the centrality of latent energies such as libidinous drives and the
need for their gratification. Moreover, they accepted the Freudian notion that social
order requires the repression of libidinal energies and their sublimation for socially
acceptable purposes. Baran himself wrote on psychoanalysis. He had been
14

associated with the Institute for Social Research in Frankfurt in the early 1930s and
was directly influenced by the work of Eric Fromm and Herbert Marcuse. It is within
15

this broad framework that a theory of mental health can be identified in Baran and
Sweezy’s analysis, with the contradictions between capitalism and human need
expressing themselves chiefly through the repression of human energies. It was
Fromm, most notably, who was to develop a unique Marxist psychoanalytical
position that remains relevant to understanding mental health in the current era of
monopoly capitalism. And it was from this that Baran, in particular, was to draw. 16

While making explicit the importance of Sigmund Freud, Fromm acknowledged his
greater debt to Karl Marx, considering him the preeminent intellectual. Accepting
17

the Freudian premise of the unconscious and the repression and modification of
unconscious drives, Fromm nonetheless recognized the failure of orthodox
Freudianism to integrate a deeper sociological understanding of the individual into
its analysis. Turning to Marxism, he constructed a theory of the individual whose
consciousness is shaped by the organization of capitalism, with unconscious drives
repressed or directed toward acceptable social behavior. While Marx never
produced a formal psychology, Fromm considered that the foundations of one
resided in the concept of alienation. For Marx, alienation was an illustration of
18

capitalism’s mortifying physical and mental impact on humans. At its heart, it


19

demonstrates the estrangement people feel from both themselves and the world
around them, including fellow humans. Alienation’s specific value for understanding
mental health lies in illustrating the distinction that emerges under capitalism
between human existence and essence. For Marx, capitalism separates individuals
from their essence as a consequence of their existence. This principle permeated
Fromm’s psychoanalytic framework, which maintained that, under capitalism,
humans become divorced from their own nature.
Human nature, Marx argued, consists of dual qualities and we “must first deal with
human nature in general, and then with human nature as modified in each historical
epoch.” There are needs that are fixed, such as hunger and sexual desires, and
20

then there are relative desires that originate from the historical and cultural
organization of society. Inspired by Marx, Fromm argued that human nature is
21

inherent in all individuals, but that its visible manifestation is largely dependent on
the social context. It is untenable to assume “man’s mental constitution is a blank
piece of paper, on which society and culture write their text, and which has no
intrinsic quality of its own.… The real problem is to infer the core common to the
whole human race from the innumerable manifestations of human nature.” Fromm 22

recognized the importance of basic biological needs, such as hunger, sleep, and
sexual desires, as constituting aspects of human nature that must be satisfied before
all else. Nonetheless, as humans evolved, they eventually reached a point of
23

transcendence, from the animal to the uniquely human. As humans found it


24

increasingly easier to satisfy their basic biological needs, largely as a result of their
mastery over nature, the urgency of their satisfaction gradually became less
important, with the evolutionary process allowing for the development of more
complex intellectual and emotional capacities. As such, an individual’s most
25

significant drives were no longer rooted in biology, but in the human condition. 26

Considering it imperative to construct an understanding of human nature against


which mental health could be evaluated, Fromm identified five central characteristics
of the human condition. The first is relatedness. Aware of being alone in the world,
humans strenuously endeavor to establish ties of unity. Without this, it is intolerable
to exist as an individual. Second, the dominance of humans over nature allows for
27

an easier satisfaction of biological needs and for the emergence of human aptitudes,
contributing to the development of creativity. Humans developed the ability to
express a creative intelligence, transforming this into a core human characteristic
that requires fulfillment. Third, humans, psychologically, require rootedness and a
28

sense of belonging. With birth severing ties of natural belonging, individuals


constantly pursue rootedness to feel at one with the world. For Fromm, a genuine
sense of belonging could only be achieved in a society built on solidarity. Fourth,
29

humans crucially desire and develop a sense of identity. All individuals must
establish a sense of self and an awareness of being a specific person. Fifth, it is
30

psychologically necessary for humans to develop a framework through which to


make sense of the world and their own experiences. 31
Representing what Fromm argued to be a universal human nature, the satisfaction
of these drives is essential for optimum mental well-being. As he contended, “mental
health is achieved if man develops into full maturity according to the characteristics
and laws of human nature. Mental illness consists in the failure of such
development.” Rejecting a psychoanalytical understanding that emphasizes the
32

satisfaction of the libido and other biological drives, mental health, he claimed, is
inherently associated with the satisfaction of needs considered uniquely human.
Under capitalism, however, the full satisfaction of the human psyche is thwarted. For
Fromm, the origins of poor mental health are located in the mode of production and
the corresponding political and social structures, whose organization impedes the
full satisfaction of innate human desires. The effects of this on mental health,
33

Fromm argued, are that “if one of the basic necessities has found no fulfillment,
insanity is the result; if it is satisfied but in an unsatisfactory way…neurosis…is the
consequence.” 34

Work and Creative Repression


Like Marx, Fromm asserted that the instinctual desire to be creative had the greatest
chance of satisfaction through work. In the Economic and Philosophic Manuscripts
of 1844, Marx strenuously argued that labor should be a fulfilling experience,
allowing individuals to be freely expressive, both physically and intellectually.
Workers should be able to relate to the products of their labor as meaningful
expressions of their essence and inner creativity. Labor under capitalism, however,
is an alienating experience that estranges individuals from its process. Alienated
labor, Marx contended, is when “labour is external to the worker, i.e., it does not
belong to his essential being…therefore, he does not affirm himself but denies
himself, does not feel content but unhappy, does not develop freely his physical and
mental energy but mortifies his body and ruins his mind.” Under capitalism, great
35

efforts are made to ensure human energy is channeled into labor, even though it is
often miserable and tedious. Rather than satisfying the need to express creativity,
36

it frequently represses it through the monotonous and grueling obligation of wage


labor.
37

In Britain, there is widespread dissatisfaction with work. One recent survey of


employees conducted in early 2018 estimated that 47 percent would consider
looking for a new job during the coming year. Of the reasons given, a paucity of
opportunities for career advancement was prominent, along with not enjoying work
and employees feeling like they do not make a difference. These reasons begin to
38
illustrate an entrenched alienation from the labor process. Many people experience
work as having little meaning and little opportunity for personal fulfillment and
expression.
From such evidence, a claim can be made that in Britain—as in many monopoly-
capitalist nations—a substantial portion of the labor force feels disconnected from
their work and does not consider it a creative experience. For Fromm, the realization
of creative needs are essential to being mentally healthy. Having been endowed with
reason and imagination, humans cannot exist as passive beings, but must act as
creators. Nevertheless, it is clear that work under capitalism does not achieve this.
39

Considerable evidence suggests that far from being beneficial to mental health, work
is actually detrimental to it. Although the exact figures are likely to remain unknown
due to the intangibility of such experiences, it can be inferred that, for many members
of the labor force, it is commonplace for work to provoke general unhappiness,
dissatisfaction, and despondency. Moreover, more severe mental-health conditions,
such as stress, depression, and anxiety, are increasingly emerging as the
consequences of discontentment at work. In 2017–18, such conditions constituted
44 percent of all work-related ill health in Britain, and 57 percent of all workdays lost
to ill health. An additional study in 2017 estimated that 60 percent of British
40

employees had suffered work-related poor mental health in the past year, with
depression and anxiety being some of the most common manifestations. 41

Rather than a source of enjoyment, the nature and organization of work under
capitalism clearly does not act as a satisfactory means to fulfill an individual’s
creativity. As Baran and Sweezy argued, “the worker can find no satisfaction in what
his efforts accomplish.” Instead, work alienates individuals from a fundamental
42

aspect of their nature and, in so doing, stimulates the emergence of varying negative
states of mental health. With around half of the labor force in Britain having
experienced work-related mental-health issues, and many more likely feeling a
general sense of despondency, there exists what Fromm termed a socially patterned
defect. It is no exaggeration to argue that the deterioration of mental well-being is a
43

standard response to wage labor in monopoly-capitalist societies. Negative feelings


become commonplace and, to varying degrees, are acknowledged as normal
reactions to work. With the exception of severe mental-health disorders, many forms
of mental distress that develop in response are taken for granted and not considered
legitimate problems. As such, the degradation of mental well-being is normalized.
Meaningful Association and Loneliness
For Fromm, there existed an inherent relationship between positive mental health,
meaningful personal relationships in the form of both love and friendship, and
expressions of solidarity. Acutely aware of their “aloneness” in the world, individuals
attempt to escape the psychological prison of isolation. Nonetheless, the operation
44

of capitalism is such that it frequently prevents the satisfactory fulfillment of this need.
The inadequacy of social relationships within monopoly-capitalist societies was
identified by Baran and Sweezy. They argued a frivolity had descended over much
social interaction, as it became typified by superficial conversation and a falsity of
pleasantness. The emotional commitments required for friendship and the
intellectual efforts needed for conversation were made largely absent as social
interaction became increasingly about acquaintances and small talk. Contemporary
45

monopoly capitalism is no exception. While difficulties in measuring its existence and


nature abound, arguably one the most widespread neuroses to plague present-day
capitalism is loneliness. It is increasingly considered a major public-health concern,
perhaps most symbolically evident with the establishment of a Minister for
Loneliness in 2018 by the British government.
As a neurosis, loneliness has debilitating consequences. Individuals may resort to
alcohol and drug abuse to numb their misery, while persistent experience increases
blood pressure and stress, as well as negatively impacts cardiovascular and
immune-system functioning. A mental-health condition in its own right, loneliness
46

exacerbates additional mental-health problems and is often the root cause of


depression. In 2017, it was estimated that 13 percent of individuals in Britain had
47

no close friends, with a further 17 percent having average- to poor-quality


friendships. Moreover, 45 percent claimed to have felt lonely at least once in the
previous two weeks, with 18 percent frequently feeling lonely. Although a close,
loving relationship acts as a barrier to loneliness, 47 percent of people living with a
partner reported feeling lonely at least some of the time and 16 percent
often. Reflecting the dominant scientific constructs of mental health, recent efforts
48

have been made to identify genetic causes of loneliness, with environmental


conditions said to exacerbate an individual’s predisposition to it. However, even the
49

most biologically deterministic analyses concede that social circumstances are


important to its development. Nonetheless, few studies attempt to seriously illustrate
the extent to which capitalism is a contributing factor.
Individualism has always reigned supreme as a principle upon which the ideal
capitalist society is constructed. Individual effort, self-reliance, and independence
are endorsed as the hallmarks of capitalism. As understood today, the notion of the
individual has its origins in the feudal mode of production, and its emphasis on
greater collectivist methods of labor—such as within the family or village—being
surrendered to the compulsion of individuals, who have to be free to sell their labor
power on the market. Prior to capitalism, life was conducted more as part of a wider
social group, while the transition to capitalism developed and allowed for the
emergence of the isolated, private individual and the nuclear, increasingly privatized
family. Fromm contended that the promotion and celebration of the virtues of the
50

individual means that members of society feel more alone under capitalism than
under previous modes of production. Capitalism’s exaltation of the individual is
51

made further apparent by its potent opposition to the ideals of collectivism and
solidarity, and preference and incentive for competition. Individuals, it is said, must
compete with each other on a general basis to enhance their personal development.
More specifically, competition is, economically, one of the bases on which the market
operates and, ideologically, corresponds to the widespread belief that, to be
successful, one must compete with others for scarce resources. The consequence
of competition is that it divides and isolates individuals. Other members of society
are not considered as sources of support, but rather obstacles to personal
advancement. Ties of social unity are therefore greatly weakened. Thus, loneliness
is embedded within the structure of any capitalist society as an inevitable outcome
of its value system.
Not only is loneliness integral to capitalist ideology, it is also exacerbated by the very
functioning of capitalism as a system. As a result of capitalism’s inexorable drive for
self-expansion, the growth of production is one of its elementary characteristics.
Having become an axiomatic notion, rarely is the idea of expanded production
challenged. The human cost of this is crippling as work takes precedence over
investing in social relationships. Furthermore, neoliberal reforms have left many
workers with progressively more precarious jobs and less protections, guaranteed
benefits, and hours of employment—all of which have only aggravated loneliness.
Amplifying the proletarianization of the labor force, with ever-more workers existing
in a state of insecurity and experiencing increased exploitation, the centrality of work
has become greater as the threat of not having a job, or being unable to secure an
adequate standard of living, has become a reality for many in a “flexible” labor
market. Individuals have no choice but to devote more time to work at the expense
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of establishing meaningful relationships.


The growing attention given to work can be illustrated in relation to working practices.
Despite the fact that the average length of the working week increased in Britain
following the financial crisis of 2007–09, the broader picture over the last two
decades has officially been one of decline. Part-time workers, however, have
witnessed the number of hours they work increase, along with the number of part-
time jobs. Additionally, between 2010 and 2015, there was a 15 percent rise in the
number of full-time members of the labor force working more than forty-eight hours
per week (the legal limit; additional hours must be agreed upon by employer and
employee). Furthermore, in 2016, one employee survey illustrated that 27 percent
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worked longer than they would like, negatively impacting their physical and mental
health, and 31 percent felt that their work interfered with their personal
life. Significantly, loneliness is not just a feature of life outside of work, but a
54

common experience during work. In 2014, it was estimated that 42 percent of British
employees did not consider any coworker to be a close friend, and many felt isolated
in the workplace.
Greater engagement in productive activities at the expense of personal relationships
has been labeled the “cult of busyness” by psychiatrists Jacqueline Olds and Richard
Schwartz. While they accurately identify this trend, they nonetheless evaluate it in
55

terms of workers freely choosing such a life. This elides any serious criticisms of
capitalism and the reality that the cult of busyness has largely been an outcome of
the economic system’s inherent need for self-expansion. Furthermore, Olds and
Schwartz fail to accept the trend as a reflection of the structural organization of the
labor market, which makes more work a necessity instead of a choice. The
avoidance of loneliness and the search for meaningful relationships are fundamental
human desires, but capitalism suppresses their satisfactory fulfillment, along with the
opportunities to form common bonds of love and friendship, and to work and live in
solidarity. In response, as Baran and Sweezy argued, the fear of being alone drives
people to seek some of the least fulfilling social relationships, which ultimately result
in feelings of greater dissatisfaction.
56

Materialism and the Search for Identity and


Creativity
For monopoly capitalism, consumption is a vital method of surplus absorption. In the
era of competitive capitalism, Marx could not foresee how the sales effort would
evolve both quantitatively and qualitatively to become as important for economic
growth as it has. Advertising, product differentiation, planned obsolescence, and
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consumer credit are all essential means of stimulating consumer demand. At the
same time, there is no shortage of individuals willing to consume. Alongside the
acceptance of work, Fromm identified the desire to consume as an integral
characteristic of life under capitalism, arguing it was a significant example of the uses
to which human energies are directed to support the economy. 58

With consumer goods valued for their conspicuity rather than their intended function,
people have gone from consuming use values to symbolic values. The decision to
engage in popular culture and purchase a type of automobile, brand of clothing, or
technological equipment, among other goods, is frequently based on what the
product is supposed to convey about the consumer. Frequently, consumerism
constitutes the principal method through which individuals can construct a personal
identity. People are emotionally invested in the meanings associated with consumer
goods, in the hope that whatever intangible qualities items are said to possess will
be passed on to them through ownership. Under monopoly capitalism, consumerism
is more about consuming ideas and less about satisfying inherent biological and
psychological needs. Fromm contended that “consumption should be a concrete
human act in which our senses, bodily needs, our aesthetic taste…are involved: the
act of consumption should be a meaningful…experience. In our culture, there is little
of that. Consuming is essentially the satisfaction of artificially stimulated
phantasies.” 59

The need for identity and creative fulfillment encourages an insatiable appetite to
consume. Each purchase, however, regularly fails to live up to its promise. Rarely is
satisfaction truly achieved through consumption, because what is being consumed
is an artificial idea rather than a product that imbues our existence with meaning. In
this process, consumerism as a form of alienation becomes evident. Instead of
consuming a product designed to satisfy inherent needs, consumer goods exemplify
their synthetic nature via their manufactured meanings and symbolisms, which are
designed to stimulate and satisfy a preplanned response and need. Any identity a
60

person may desire, or feel they have obtained, from consuming a product, as well
as any form of creativity invoked by a consumer good or item of popular culture, is
false.
Rather than cultivating joy, the affluence of the monopoly-capitalist nations has bred
a general widespread dissatisfaction as high value is placed on amassing
possessions. While consumerism as a value exists in all capitalist societies, in those
of greater inequality—with Britain displaying wider wealth disparities than most—the
desire to consume and acquire greatly contributes to the emergence of neuroses,
as the effort to maintain social status and emulate those at the top of society
becomes an immense strain. The impact of this has been demonstrated within British
families in recent years. In 2007, UNICEF identified Britain as having the lowest level
of child well-being out of twenty-one of the most affluent Organisation for Economic
Co-operation and Development nations. In response, an analysis of British families
was conducted in 2011 comparing them to those in Spain and Sweden, countries
that ranked in the top five for child well-being.
61

Of the three nations, the culture of consumerism was greatest in Britain, as it was
prevalent among all families regardless of affluence. British parents were considered
more materialistic than their Spanish and Swedish counterparts and behaved
accordingly toward their children. They purchased the most up-to-date, branded
consumer goods, largely because they thought it would ensure their child’s status
among their peers. This was a value shared by the children themselves, with many
accepting that social prestige was based on ownership of branded consumer goods,
which, evidence suggests, contributed to arising worry and anxiety, especially for
children from poorer households who recognized their disadvantage. While a
compulsion to purchase new goods continuously for themselves and their children
was identified among British parents, many nonetheless also felt the psychological
strain of attempting to maintain a materialistic lifestyle and caved to such pressures.
Across all three countries, children identified the needs for their own well-being as
consisting of quality time spent with parents and friends, and opportunities to indulge
their creativity, especially through outdoor activities. Despite this, the research
showed that, in Britain, many were not having such needs satisfied. Parents
struggled to spend enough time with their children due to work commitments and
often prevented them from participating in outdoor activities due to safety concerns.
Subsequently, parents compensated for this with consumer goods, which largely
failed to meet their children’s needs. As such, the needs of British children to form
and partake in meaningful relationships and act creatively were repressed, and
efforts to satisfy these needs through consumerism failed to bring them happiness.

Resistance as Class Struggle


While not denying the existence of biological causes, the structural organization of
society must be recognized as having serious repercussions on people’s mental
health. Monopoly capitalism functions to prevent many from experiencing mental
well-being. Yet, despite this, the medical model continues to dominate, reinforcing
an individualistic conception of mental health and obscuring the detrimental effects
of the present mode of production. This oppresses users of mental-health services
by subordinating them to the judgment of medical professionals. The medical model
also encourages the suspension and curtailment of individuals’ civil rights if they
experience mental distress, including by legitimizing the infringement of their
voluntary action and excluding them from decision-making. For those who suffer
mental distress, life under capitalism is frequently characterized by oppression and
discrimination.

Aware of their oppressed status, users and survivors of mental-health services are
now challenging the ideological dominance of the medical model and its obfuscation
of capitalism’s psychological impact. Furthermore, they are increasingly coalescing
around and putting forward as an alternative the need to accept the Marxist-inspired
social model of mental health. The social model of disability identifies capitalism as
instrumental to the construction of the category of disability, defined as impairments
that exclude people from the labor market. Adopting a broadly materialist
perspective, a social model of mental health addresses material disadvantage,
oppression, and political exclusion as significant causes of mental illness.

In 2017 in Britain, the mental-health action group National Survivor User Network
unequivocally rejected the medical model and planted social justice at the heart of
its campaign. As part of its call for a social approach to mental health, the group
explicitly denounces neoliberalism, arguing that austerity and cuts to social security
have contributed to the increasing prevalence of individuals who suffer from poor
mental health as well as to the exacerbation of existing mental-health issues among
the population. Recognizing social inequality as a contributor to the emergence of
poor mental health, National Survivor User Network proposes that the challenge
posed by mental-health service users should be part of a wider indictment of the
general inequality in society, arguing that “austerity measures, damaging economic
policies, social discrimination and structural inequalities are causing harm to people.
We need to challenge this as part of a broader social justice agenda.” Furthermore,
62

the action group Recovery in the Bin positions itself and the wider mental-health
movement within the class struggle, pushing for a social model that recognizes
capitalism as a significant determinant of poor mental health. Moreover, representing
ethnic minorities, Kindred Minds vigorously campaigns on an understanding that
mental distress is less a result of biological characteristics and more a consequence
of social problems such as racism, sexism, and economic inequality “pathologised
as mental illness.” For Kindred Minds, the catalyst for deteriorating mental health is
63
oppression and discrimination, with ethnic minorities having to suffer greater levels
of social and economic inequality and prejudice.
Capitalism can never offer the conditions most conducive to achieving mental health.
Oppression, exploitation, and inequality greatly repress the true realization of what
it means to be human. Opposing the brutality of capitalism’s impact on mental well-
being must be central to the class struggle as the fight for socialism is never just one
for increased material equality, but also for humanity and a society in which all
human needs, including psychological ones, are satisfied. All members of society
are affected by the inhumane nature of capitalism, but, slowly and determinedly, the
fight is being led most explicitly by the most oppressed and exploited. The challenge
posed must be viewed as part of the wider class struggle, as being one front of many
in the fight for social justice, economic equality, dignity, and respect.

Notes
1. ↩ World Health Organization, Fact Sheets on Mental Health (Geneva: World Health Organization,
2017), http://who.int.
2. ↩ World Health Organization, Data and Resources (Geneva: World Health Organization, 2017),
http://euro.who.int/en.
3. ↩ World Health Organization, Data and Resources.
4. ↩ Sally McManus, Paul Bebbington, Rachel Jenkins, and Traolach Brugha, Mental Health and
Wellbeing in England: Adult Psychiatric Morbidity Survey 2014 (Leeds: NHS Digital, 2016).
5. ↩ Brett J. Deacon and Dean McKay, “The Biomedical Model of Psychological Problems: A Call for
Critical Dialogue,” Behavior Therapist 38, no. 7 (2015): 231–35. Pharmaceutical companies who have
identified it as a market opportunity have been the primary beneficiaries of this approach, exemplified
by the proliferation of anti-depressants as illustrated by Brett J. Deacon and Grayson L. Baird, “The
Chemical Imbalance Explanation of Depression: Reducing Blame at what Cost?,” Journal of Social
and Clinical Psychology 28, no. 4 (2009): 415–35.
6. ↩ As exemplified by Jordan W. Smoller et al., “Identification of Risk Loci with Shared Effects on
Five Major Psychiatric Disorders: A Genome-Wide Analysis,” Lancet 381, no. 9875 (2013): 1371–79.
In this study, five of the most common mental-health disorders, including schizophrenia, bipolar
disorder, and depression, were associated with genetic variations.
7. ↩ Deacon and McKay, “The Biomedical Model of Psychological Problems,” 233.
8. ↩ Social class is one of the most significant indicators of mental health, as evidenced by research
within the social sciences dating back to the earlier part of the twentieth century. The first most notable
study of this kind is Robert E. L. Farris and Henry W. Dunham, Mental Disorders in Urban
Areas (Chicago: Chicago University Press, 1939), which identified higher rates of mental disorders in
the poorest districts of Chicago. This was followed by, among others in both Britain and the United
States, August B. Hollingshead and Frederick C. Redlich, Social Class and Mental Illness (New York:
John Wiley, 1958); Leo Srole, Thomas S. Langer, Stanley T. Michael, Marvin K. Opler, and Thomas
A. C. Rennie, Mental Health in the Metropolis: The Midtown Manhattan Study (New York: McGraw-
Hill, 1962); and John J. Schwab, Roger A. Bell, George J. Warheit, and Ruby B. Schwab, Social Order
and Mental Health: The Florida Health Study (New York: Brunner-Mazel, 1979).
9. ↩ Iain Ferguson, Politics of the Mind: Marxism and Mental Distress (London: Bookmarks, 2017),
15–16.
10. ↩ Paul Baran and Paul Sweezy, Monopoly Capital (New York: Monthly Review Press, 1966), 285.
11. ↩ Baran and Sweezy, Monopoly Capital, 346–47.
12. ↩ Baran and Sweezy, Monopoly Capital, 346.
13. ↩ Baran and Sweezy, Monopoly Capital, 364.
14. ↩ Baran and Sweezy, Monopoly Capital, 354–55.
15. ↩ Paul A. Baran, The Longer View (New York: Monthly Review Press, 1969), 92–111; Paul M.
Sweezy, “Paul A. Baran: A Personal Memoir,” in Paul A. Baran: A Collective Portrait (New York:
Monthly Review Press, 32–33. The unpublished chapter of Baran and Sweezy’s Monopoly Capital,
entitled “The Quality of Monopoly Capitalist Society II,” drafted by Baran, had included an extensive
section on mental health. That chapter, however, was not included in the book because it was still
unfinished at the time of Baran’s death. Nevertheless, some elements of the mental-health argument
were interspersed in other parts of the book. When “The Quality of Monopoly Capitalism II” was finally
published in Monthly Review in 2013, almost sixty years after it was drafted by Baran, the section on
mental health was excluded due to its incomplete character. See Paul A. Baran and Paul M. Sweezy,
“The Quality of Monopoly Capitalist Society: Culture and Communications” Monthly Review 65, no.
3 (July–August 2013): 43–64. It is worth noting that the treatment of mental health in Monopoly
Capital did not go unnoticed and was subject to criticism by Robert Heilbroner in a review in the New
York Review of Books, to which Sweezy responded in a letter, defending their analysis in this regard.
See Robert Heilbroner, Between Capitalism and Socialism (New York: Vintage, 1970), 237–46; Paul
M. Sweezy, “Monopoly Capital” (letter), New York Review of Books, July 7, 1966, 26.
16. ↩ The influence of Fromm is evident in Baran’s work and correspondence. He studied Fromm’s The
Sane Society, together with Marcuse’s Eros and Civilization and One Dimensional Man (in manuscript
form). He was undoubtedly familiar with the wider body of work by both thinkers. While Baran was
not in complete agreement with the details of Marcuse’s analyses, he openly acknowledged the
importance and significance of his work, identifying Eros and Civilization as having great relevance to
U.S. society and recognizing a psychoanalytical analysis as vital to understanding monopoly-capitalist
society. See Nicholas Baran and John Bellamy Foster, The Age of Monopoly Capital: Selected
Correspondence of Paul A. Baran and Paul M. Sweezy, 1949–1964 (New York: Monthly Review Press,
2017), 127, 131. See also the “Baran-Marcuse Correspondence,” Monthly Review Foundation,
https://monthlyreview.org.
17. ↩ Erich Fromm, Beyond the Chains of Illusion: My Encounter with Freud and Marx (London:
Continuum, 2009), 7.
18. ↩ Fromm, Beyond the Chains of Illusion, 35.
19. ↩ Bertell Ollman, Alienation: Marx’s Conception of Man in a Capitalist Society (Cambridge:
Cambridge University Press, 1977), 131.
20. ↩ Karl Marx, Capital, vol. 1 (1867; repr. London: Lawrence and Wishart, 1977), 571.
21. ↩ Erich Fromm, Marx’s Concept of Man (London: Bloomsbury, 2016), 23–24.
22. ↩ Erich Fromm, The Sane Society (London, Routledge, 2002), 13.
23. ↩ Fromm, The Sane Society, 65.
24. ↩ Fromm, The Sane Society, 22.
25. ↩ Fromm, Beyond the Chains of Illusion, 27.
26. ↩ Fromm, The Sane Society, 27.
27. ↩ Fromm, The Sane Society, 28–35.
28. ↩ Fromm, The Sane Society, 35–36.
29. ↩ Fromm, The Sane Society, 37–59.
30. ↩ Fromm, The Sane Society, 59–61.
31. ↩ Fromm, The Sane Society, 61–64
32. ↩ Fromm, The Sane Society, 14.
33. ↩ Fromm, The Sane Society, 76.
34. ↩ Fromm, The Sane Society, 66.
35. ↩ Karl Marx, Economic and Philosophic Manuscripts of 1844 (1932; repr. Radford, Virginia: Wilder
Publications, 2011).
36. ↩ Fromm, Beyond the Chains of Illusion, 63.
37. ↩ Fromm, The Sane Society, 173.
38. ↩ Investors in People, Job Exodus Trends: 2018 Employee Sentiment Poll (London: Investors in
People, 2018), http://investorsinpeople.com.
39. ↩ Fromm, The Sane Society, 35.
40. ↩ Health and Safety Executive, Work Related Stress, Depression or Anxiety Statistics in Great
Britain, 2018 (Bootle, UK: Health and Safety Executive, 2018), 3, http://hse.gov.uk.
41. ↩ Business in the Community, Mental Health at Work Report 2017 (London: Business in the
Community, 2017), http://bitc.org.uk.
42. ↩ Baran and Sweezy, Monopoly Capital, 345.
43. ↩ Fromm, The Sane Society, 15.
44. ↩ Fromm, The Sane Society, 29.
45. ↩ Baran and Sweezy, Monopoly Capital, 347–48.
46. ↩ Jo Griffin, The Lonely Society? (London: Mental Health Foundation, 2010), 6–7.
47. ↩ Griffin, The Lonely Society?, 4
48. ↩ David Marjoribanks and Anna Darnell Bradley, You’re Not Alone: The Quality of the UK’s Social
Relationships (Doncaster: Relate, 2017), 17–18.
49. ↩ Luc Goossens, Eeske van Roekel, Maaike Verhagen, John T. Cacioppo, Stephanie Cacioppo,
Marlies Maes, and Dorret I. Boomsma, “The Genetics of Loneliness: Linking Evolutionary Theory to
Genome-Wide Genetics, Epigenetics, and Social Science,” Perspectives on Psychological Science 10,
no 2 (2015): 213–26.
50. ↩ Michael Oliver, The Politics of Disablement (Basingstoke, UK: Macmillan Press, 1990); Eli
Zaretsky, Capitalism, the Family, and Personal Life (London: Pluto Press, 1976).
51. ↩ Fromm, The Fear of Freedom, 93.
52. ↩ See Ricardo Antunes, “The New Service Proletariat,” Monthly Review 69, no. 11 (April 2018): 23–
29, for an analysis of the evolving insecurity of labor markets within the advanced capitalist nations
and the hardening of proletarian divisions.
53. ↩ Trade Union Congress, “15 Per Cent Increase in People Working More than 48 Hours a Week
Risks a Return to ‘Burnout Britain’, Warns TUC,” September 9, 2015; Josie Cox, “British Employees
are Working More Overtime than Ever Before—Often for No Extra Money,” Independent, March 2,
2017.
54. ↩ David Marjoribanks, A Labour of Love—or Labour Versus Love?: Our Relationships at Work;
Relationships and Work (Doncaster: Relate, 2016).
55. ↩ Jacqueline Olds and Richard Schwartz, The Lonely American: Drifting Apart in the Twenty-First
Century (Boston: Beacon Press, 2009).
56. ↩ Baran and Sweezy, Monopoly Capital, 347–48.
57. ↩ Baran and Sweezy, Monopoly Capital, 115.
58. ↩ Fromm, Beyond the Chains of Illusion, 63.
59. ↩ Fromm, The Sane Society, 129-130.
60. ↩ Robert Bocock, Consumption (London: Routledge, 2001), 51.
61. ↩ United Nations Children’s Fund, Innocenti Report Card 7: Child Poverty in Perspective: An
Overview of Child Well-Being in Rich Countries (Florence: UNICEF Innocenti Research Centre, 2007),
http://unicef-irc.org.
62. ↩ National Survivor User Network, NSUN Manifesto 2017: Our Voice, Our Vision, Our Values,
(London: National Survivor User Network, 2017), http://nsun.org.uk.
63. ↩ Raza Griffiths, A Call for Social Justice: Creating Fairer Policy and Practice for Mental Health
Service Users from Black and Minority Ethnic Communities (London: Kindred Minds, 2018).