Mental Health Mantra
If you believe vocal lobbies, we can never devote enough resources to tackle our ongoing mental health crisis. Politicians of all hues like to champion the rights of mental health patients to better care. They try to score points on the perceived lack of funding for mental health services. The subtext is that we should treat mental health just like physical health and it is thus the business of healthcare providers not only to check your blood pressure and heart rate, but to analyse your state of mind.
Unlike physical health, mental health is highly subjective. What kinds of moods and behavioural patterns are so dysfunctional or antisocial that they merit the proactive intervention of third-party supervisors whether in the guise of counsellors, social workers, psychiatric nurses or psychologists. This paternalistic approach raises many questions about personal independence and freedom. Until recently we just assumed that happiness is mere expression of satisfaction with life. Yet it is hard to detect any correlation between prosperity and happiness, except in a looser relative sense. Above all people need security, a sense of belonging and some love and affection. We often substitute ephemeral pleasures of temporary stupefaction or indulgence for true contentment gradually won through hard work. The abundance of consumer goods and a generous welfare state have jointly undermined the great art of delayed gratification and replaced it with a sense of entitlement that can often create an emotional void and an insatiable demand for more and better.
It seems only fair to care for vulnerable members of our community. If we were talking about paraplegics, everyone would understand why their disability, paralysis of the lower body, merits some help from the rest of us. Indeed with assistive technology most paraplegics can lead fruitful lives. However, few would choose to be cripples and most would welcome medical breakthroughs to help them walk again. If the incidence of paraplegia were to double every twenty years, we would seriously have to address the root causes for society relies on the able-bodied to assist the physically disabled. If we are unable to look after ourselves unassisted, we inevitably depend on the goodwill of others to act in our best interests. Our personal freedom is ultimately limited by our dependence on others for our basic needs. These days few of us could be truly self-sufficient, unless we adapted to a humble existence as subsistence farmers, so a paraplegic is only relatively more at the mercy of external agencies than your average able-bodied citizen. Arguably a talented cripple able to work remotely as a writer, designer or programmer may contribute more to society than an able-bodied drug-addict who cannot hold down a menial job. However, by promoting the concept of mental ill-health we greatly widen the range of people unable to fend for themselves without intrusive help.
Who exactly decides who is and who is not mentally fit? What criteria do we apply? If you can only run a hundred metres before running out of breath, are you physically disabled? Of course not, though you may be relatively unfit and should probably get some more exercise. Your doctor would probably advise you not to overdo it and set simple attainable goals and slowly adapt your lifestyle. However, if you fractured your spine in a horrific workplace accident, you may well lose control of your legs and suddenly countless everyday tasks like getting dressed or going to the bathroom become almost impossible to accomplish without some help. You are not simply unfit, but genuinely disabled. A disability, by its customary definition, prevents you from accomplishing essential life-sustaining tasks. It is not a relative handicap. If you're tone-deaf, but able to speak and understand a human language, you are not disabled, but just have a relative weakness in one facet of human creativity. Musical aptitude is certainly a nice to have and arguably gives you an advantage in natural selection, but many tone-deaf people have led fruitful lives without requiring any special help. Tone-deafness is also a rather relative concept as are relative intellectual deficits in mathematics, literacy or dexterity. While we may debate the causes of our relative strengths and weaknesses, modern society relies on functional and intellectual diversity. We cannot all be playwrights, musicians or comedians, but society would be dull without artistic creativity. However, it would cease to function without farmers, builders, engineers, plumbers, toilet cleaners or nurses. We can only relax and have fun once we have provided all infrastructure, food, clean water, shelter and other amenities essential to comfortable human existence. Technological progress and societal pressures have redefined our concept of comfort. Recent technological and economic trends have revealed two paradoxes. First automation and globalisation have displaced millions of manual workers, increasing competitiveness and lowering wages at the bottom end of the labour market. Second as material living standards have risen our emotional well-being has not. Greater labour mobility may have boosted the economy but it has led to greater job insecurity at a time when most women and men are expected to participate in the financial economy. Our personal worth is no longer measured by the roles we play in our family and community, but by our utility as a player in a dynamic consumption-driven market economy. Since the 1970s in much of Western Europe we've seen a gradual shift from practical trades to abstract tertiary sector roles involved in endless lifestyle and product promotion as well as the micromanagement of every aspect of human interaction. The UK now has more social workers than farmers, more accountants than carpenters and more IT recruiters than software developers. Yet we all need food, furniture and mobile communication. As we lose touch with the fruits of our endeavours, we begin to lose our sense of purpose in life other than the mere acquisition of money as a means of ersatz self-validation.
Not only is employment less secure, but human relationships are more volatile and communities more fluid and transient than ever before. By most measures material living standards have never been so high, but people are not only more indebted, but in the absence of paid employment or welfare payments only a few pay cheques away from financial ruin with little means to survive in the wild.
Our current obsession with mental health is the result of extreme interdependence. A quick glance at the commonest professions in the UK reveals a rather disquieting picture. Fewer and fewer workers have any direct relationship to the production and maintenance of essential goods and services, excepts as managers, sales personnel or hauliers. In the UK over six million are employed in mainly administrative roles, some requiring some limited technical expertise or prior hands-on experience, over 3 million are employed in sales, marketing and business presentation, with only 300,000 employed in farming and fishing and around one million in manufacturing, but the biggest growth sectors are personal care and surveillance. The last-named sector encompasses not just policing, but social work and psychiatric services. An ageing population and technological innovation can partly explain this phenomenon, but not entirely, especially as older people are now fitter and many can live independently well into their 80s. A growing proportion of working age adults require assistance as a result of a learning disability, mood or personality disorder.
The Human Spectrum
Until the mid 1980s psychiatric disorders only referred to extreme cases of dysfunctional behaviour. Much of the literature on the relative merits of psychotherapy or pharmacological treatment relates to individuals who posed a direct threat to themselves and/or to wider society. They accounted for under 1% of the general population and as therapeutic care improved most could rejoin the community as normal citizens. Psychiatry had been tarnished by its association with authoritarian regimes, not least in Nazi Germany where schizophrenics were euthanised alongside the mentally handicapped, but also extensively in the Soviet Union where dissidents were routinely treated in psychiatric institutions. Freedom meant above all the freedom to be yourself, to be the master of your feelings and to act an autonomous player in a wider social reality. Of course personal behaviour is regulated by social mores and a fine balance between rights and responsibilities that we learn from our family and community. However, as we gained more free time, we could unleash our individuality and creativity in more expressive ways. Not surprisingly many of the mental ailments now falling under the broad umbrella of mental illness were first observed among the professional classes. The working classes were until recently too busy working to indulge in the kind of fantasies that would preoccupy early psychotherapists. Alcohol remained the main release valve for emotional insecurity and deviant behaviour was either managed within the community or treated as criminality.
To gain greater public acceptance, psychiatry needed a complete rebrand. As the age of self-centred narcissism deepened its roots in North American society, people became more preoccupied with their moods and feelings. New Selective Serotonin Re-uptake Inhibitors such as fluoxetine, also known as Prozac, proved a huge marketing success. By the late 1990s taking mood-enhancing medication had not just become socially acceptable, they had helped blur the boundaries between a normal range of human emotions and psychopathy. Meanwhile concerned parents and teachers began to refer boisterous children unable to pay attention in class to be diagnosed with Attention Deficit Hyperactivity Disorder with a seemingly tailor-made drug, methylphenidate better known as Ritalin. In the same period we saw a rapid rise in the diagnosis of hitherto rare neurological disorders on the autistic spectrum. This craze for psychiatric labelling spread to Europe, usually accompanied by awareness-raising campaigns. Psychiatry had now donned the clothes of the progressive left championing the cause of sufferers of these new labels and thus creating new victim groups demanding special treatment. More and more young people began to contextualise their problems in terms of a psychiatric diagnosis.
Marketing Personality Disorders
The more troublesome behavioural disorders that would have merited a psychiatric diagnosis did not lend themselves to marketing, but only to occasional awareness raising initiatives. Nobody could claim pride in psychopathic madness or subnormal idiocy. However, people can be persuaded to claim pride in geekishness, hyperactivity, obsession, sudden mood swings or certain learning challenges if celebrities share some of these traits. Indeed many high-profile media personalities have publicised their diagnosis with OCD, bipolar disorder, ADHD, Aspergers' Syndrome and even learning disabilities. These traits may have their challenges, but also their advantages especially in creative professions. Other past and present luminaries have been posthumously diagnosed. Albert Einstein is claimed to have suffered or benefited from Asperger's Syndrome. It's even been claimed that multibillionaire IT entrepreneur, Bill Gates, has this syndrome too. As the mental health industry widens the diagnostic criteria for personality disorders, we begin to uncover traits common in almost all of us. Excellence in any endeavour is impossible without focussing on the task at hand. It's thus absurd to claim that a special interest in a circumscribed subject is any way pathological. It may be relatively dysfunctional if it prevents us from doing more important things essential to our wellbeing, but we would have made little technological or social progress if some people had not dedicated their professional lives to specialist subjects that few others understand. Our complex high-tech society depends on hyper-specialisation, but as noted elsewhere, most specialists are involved in various aspects of communication, administration and supervision rather than in the hard science that makes our modern lives possible. By promoting the concept of neurological diversity, the authorities can now treat different groups of people in different ways.
Inevitably, some readers will feel a little confused. Most of us have friends or family members who face significant personal challenges. You may have had episodes of emotional distress yourself. Indeed one may argue if you have never experienced sorrow, rejection or isolation, you have led a very sheltered life and will probably struggle to understand the real-life experiences of most members of our society. Should we help an anorexic girl starving herself to death for fear of becoming morbidly obese, a severely depressed teenager confined to his bedroom or a troubled young man plotting to save humanity from a contagious virus by killing his next door neighbour because he works in a pharmaceutical testing laboratory? Of course, but we need to understand the true causes of such seemingly illogical behaviour, e.g. is the rise in eating disorders related to our obsession with perfect bodies, advertising, size-zero models and media obsession with obsesity?
Alphas, Betas, Gammas, Deltas and Epsilons
In Aldous Huxley's prescient vision of a distant technocratic future, humanity had ceased to procreate naturally and was socially and biologically organised in 5 distinctive castes, ranging from high-IQ but potentially moody Alphas to low-IQ but happy Epsilons. However, everyone took pride in their own cast identity rather than fret about their relative social or intellectual status. In Huxley's Brave New World every aspect of life from conception to death was micromanaged and any psycho-social tensions were managed by the wonder potion, Soma (Sanskrit for he body as distinct from the soul, mind, or psyche) and recreational sex. Today's Soma takes various forms. Besides obvious analogies with anti-depressants and other psychoactive drugs, the mass entertainment business and recreational stimulants play an important role in managing the general population, turning us into compliant consumers and loyal team players rather than awkward free agents. Increasingly political opinions at variance with the neoliberal globalist orthodoxy are associated with maverick personal types, i.e. rather than tackle a philosophical viewpoint head-on, the new establishment will parody it and insinuate that proponents of such views suffer from some form of paranoid delusion. Democracy thus serves no longer to reflect the true will of citizens, but to manage different groups of people in order to manufacture consent with political agendas promoted by powerful lobbies.
Joining the Dots
We should view the neuological categorisation of human beings alongside other trends for cosmetic surgery, assisted fertilisation, gender reassigment and the potential for artificial intelligence to empower the technocratic elite. Now under the pretext of combatting childhood depression and/or bullying, the authorities feel empowered to subject all children to mandatory mental health screening, while simultaneously encouraging non-traditional family structures, facilitating fertility treatment, now available on the NHS irrespective of relationship status and heavily subsidising mothers going to work, even if their earnings are less than equivalent cost of childcare. All these phenomena remove children from traditional biological families and transfer responsibility for their socialisation away from parents to corporate institutions. Natural variations in human behaviour are analysed in detail to identify individuals that fail to respond to mainstream socialisation and psychological conditioning techniques and may thus become, in the authorities' eyes, troublemakers.
Concern about mental health, while often well-intentioned, provides the ultimate pretext to expand the surveillance state. As the saying goes, the road to hell is paved with good intentions.