Mental health in a sick society: what are people for?

Abstract

Now that work with our hands has been replaced, in the industrialised world, either by machines, or by cheaper labour in less developed economies, the capacity to work depends increasingly on mental health.  In the industrialised world, each year roughly one third of all adults meet consensus criteria for mental illness.  In my work as a family doctor I became very interested in helping my patients with mental illness, particularly the small number with psychotic illness, who are still mostly regarded as a responsibility for hospital-based specialists.  Family doctors are well placed to anticipate, and often to prevent, crises and emergencies arising from mental illness. In my experience they can certainly do this, if they take the trouble to know their patients, and organise continuing care around continuity and respect for patients’ stories, rather than merely respond to each problem as an isolated episode.  This has become increasingly difficult, as governments have sought to remodel all health care on the same patterns of management and employee incentives as industrial commodity production for profit. 

Psychosis is a far more manageable problem than the other 90 per cent of recognised mental illness, linked with the apparent failure of unhappiness and dysfunctional behaviour of entire societies to diminish, even when average incomes and measures of physical health have substantially improved. We should stop looking for biochemical mechanisms and start looking at social causes, and what we can do to reduce and oppose them.  What do most of these unhappy, fearful, or unreasonable people have in common, who have no disease but are certainly ill? They can find no secure or satisfying place in this world, or belief in any alternative. Their views are not so much irrational, as dysfunctional responses to an irrational society.  With the demise of manufacture and the changing nature of work generally over the last three decades, and the individual's role as consumer called into question amidst the current economic crisis, the preposterous question is put on the agenda: "What are people for?" It is capitalist society’s failure to provide any consistent answer to this question which drives most of our unhappiness and some of our madness.  While it is dangerous to generalise about mental illness, for the 90 per cent of mentally sick people who have no chemical disturbance of brain function, what they need is not more biochemical tinkering, but greater understanding of our world and their own relation to it, so that they can begin to take an effective share in making a better future for us all.