Trans healthcare, already woefully inadequate prior to the COVID-19 outbreak, has been stretched to breaking point. The Pandemic has left trans people across Britain without access to essential medical care. We need a socialist system based on bodily sovereignty and informed consent.
CW: mental illness, self-harm, suicide
Marxist commentator Pitchfork Cosmonaut writes about how the alienation and exploitation we experience under capitalism create the perfect environment for poor mental health.
Self-injury and suicide are last resorts for communicating distress in a society which doesn’t listen and mental illness is often explained away by placing responsibility on the individuals who suffer it. Biological or genetic factors are emphasised and lead to focus on treatments which further place the burden of responsibility on sufferers who are considered to have simply lost on the genetic lottery. Treatments, from pharmaceuticals to electrocution (still used in Britain) to a variety of therapies, do this: Cognitive Behavioural Therapy (CBT) for example, which is basically a form of guided self-help. Aside from more vicious forms like electrocution, this is not to dismiss any out-of-hand: I take meds daily which help alleviate my depression and I have benefited from CBT.
The point I want to make here is not about dissuading people from using any potential method of making their lives less difficult, but to see mental illness as a way of experiencing a socio-economic system. We must not allow the dominant narrative to absolve the system of its overwhelming contribution to mental illness. What’s more, not only are we made out to be the cause of our own suffering, the real cause purports itself to be the solution. A favourite tactic of liberal (i.e. capitalist) states is to offer universal provision in principle only – in reality every effort is made to find reasons not to deliver on promises (this is plain to see in our social security system where having a third child disqualifies claimants from the same payments as with their first or second. Or in our supposedly ‘universal free healthcare’ which excludes teeth, eyes, and various other things). Reasons are found to exclude as many as possible from the terms of provision, while allowing the providers to still claim moral high ground.
The fact is that there are very clear roots in our economic system and social structure. At the very least, an array of mental issues, including depression and stress, anxiety and phobias, schizophrenia, eating disorders and dysmorphia, obsessions and compulsions, PTSD, psychosis, and ADHD, are hugely exacerbated by the society we live in – and it could be very different. There are clear alternatives which could minimise suffering, quell root causes, and be much better positioned to deal with and treat symptoms. Of course, there are further questions about why for some and not others these social ills become pathological and/or chronic – but we all face these issues on some level.
Households in the lowest 20% income bracket in Britain are 2–3 times more likely to develop mental health problems than those in the highest. The system of capitalism, whereby a class of owners extract capital from a class of workers producing for profit rather than need and subsisting on wage labour, is inherently contradictory and unstable. It lurches from crisis to crisis in a cyclical boom-bust pattern. The very language used to describe this points to mental health: depression, slump etc. The crises stem from inherent contradictions within the system of capitalism. A major contradiction lies in what is usually put forward as a virtue: competition. Capitalists vie against each other for business in a zero-sum game. Losers cease to exist altogether, leaving a greater market share to the survivors. This precarity of existence is borne by workers in a number of ways. Workers at businesses who go bankrupt lose their jobs. Those at surviving businesses remain in competition and consequently suffer efforts to cut costs and increase production: wages are under constant downward pressure and workers are under ever-greater pressure to produce more for that wage – longer hours, working faster and harder. Of course, the harder the working class works for less money, the bigger the profits for the owners and the more powerful they become. The more powerful they become, the more they’re able to impose their will on the working class – the more exploitable the working class becomes, and so on. (Of course, this is a simplified picture – there are countervailing tendencies and the world is always messier in reality than the generalisations we use to understand it).
Additionally, this drive towards efficiency dictated by capitalist markets produces imperatives to streamline all parts of the production process – standardisation. If machine parts are all different shapes and sizes, this slows down production and loses businesses money. Workers are not exempt from these imperatives towards efficiency and standardisation, and so, as far as the capitalist is concerned, all workers should be as similar to the ‘ideal worker’ as possible, and if they aren’t, then efforts are made to push them in that direction. This is reflected in an ideology of ableism that pervades our culture: humans with atypical bodies and minds are deemed disabled, and so inferior.
As businesses become more successful they tend to reinvest in machinery (not forgetting that the global economy is still very much underpinned by manufacturing: while imperialist economies like Britain have shifted to service, they still largely control and extract profits from weaker economies which make all our stuff), becoming more efficient and needing fewer workers. Since workers are also consumers, ever-increasing amounts of commodities are produced with fewer consumers able to afford them. Bubbles form, expand and burst, and workers are the ones to bear the brunt. It stands to reason that the working class, as a whole, cannot buy back the full value of what it produces if owners are taking such a huge cut for themselves in the form of profit. The ever-presence of crises and businesses either cutting costs or going bust, means that unemployment is also a perennial feature.
So – those in work suffer job insecurity and continuous competition with colleagues either for promotion or simply to stay employed. They suffer from the stress of targets, deadlines and a dog-eat-dog environment where workers are pitted against fellow workers – are we surprised that a culture of bullying is so widespread? Threats of firing, however subtle, carry a sinister weight. Micromanaging, giving excessive and derogatory criticism of work where feedback is delivered as a moral failing, and the constant moving of goalposts are widespread and often derive from standard management training (for example, a multinational corporation I used to work for would regularly sack the lowest performing 5% – whether their work was to standard or not).
Meanwhile, those without work form a ‘reserve army of labour’ which puts pressure on those in work – there’s always someone to take their place, they’re expendable. And they are in a much more precarious position. In fact, many of those in work still have to deal with food, heating and shelter insecurity because wages are kept at a minimum while rents and prices increase, and the proliferation of zero hours contracts exacerbates this. And this systemic antagonism between workers engenders an atmosphere of teasing, gossip, and chauvinism. With technological advances come increasing surveillance of workers, which is used to measure and tabulate individual production and further pit colleagues against each other in competitive league tables. Overwork is pushed in a race-to-the-bottom fashion, to the detriment of work-life balance, family, friends and partners – and mental health. It also makes human relations more difficult, contributing to atomisation, loneliness and lack of community, which further damage collective mental health and weaken some of the best ways of healing ourselves.
This setting of dog-eat-dog competition is not only played out in the workplace but in the family (itself an economic unit), and the wider world where militaristic ultraviolence and mass murder are perpetrated to enforce a global apartheid. Rich nations wreak devastation upon poor nations (to keep enriching themselves and impoverishing their targets), while the perpetrators are lionised. Such an environment of militarism and hyper-aggression cannot be good for the wellbeing of those in the imperial ‘core’ – let alone those on the receiving end of it. And if all that isn’t stressful enough there’s the threat of climate change and nuclear war looming over us. The existence of a planet hospitable for future generations is anything but a certainty if capitalism continues.
Not only is capitalism stress- and anxiety-inducing, it hollows out our lives by coercion into mundane and often repetitive work that has little or no meaning for us personally and is detrimental to our individual projects of human flourishing. This is because what drives capitalism is profit: production is predicated on making money, rather than simply human need. Stuff gets made that we need only insofar as it makes a profit. Things which the well-off can buy get made in abundance, however trivial or lavish, while provision of things necessary for the masses living in poverty is neglected. A goal of relentless, never-ending economic growth is not a meaningful goal for individuals because goals need to be attainable, need to spring from personal values, and need to have a specific end. There is a huge effort to convince workers that their own projects of human flourishing happen to be whatever their job is – and some are persuaded. Some may well coincide, but that’s rare. Thus, there is an inherent lack of meaning in our system which manifests in feelings of depression for many. The Monday blues, living for the weekend, that Friday feeling, and mid-life crises are all ways we commonly refer to this meaninglessness at the core of our socio-economic system.
The fact that the system is not built for human need (indicated, for one, by the fact that 20,000+ starve to death every day in a world with enough food to feed 10 billion, and hundreds of millions are homeless or in slums), indicates who is in control of the system. Workers have little democracy, and even that is more of a façade than any meaningful involvement in how our society is run. Democracy only applies to the wealthy. The workplace is under totalitarian dictatorship – decisions are made top-down at the highest level and we all have to live with the decisions of the bosses. This has far-reaching consequences. Workers are reduced to mere tools, our bodies are treated as machinery, or at best robots, and our brains as computers – cogs in the machine, appendages to the equipment we operate. This is dehumanising and manifests in myriad ways. Though we create much of the value that transforms into capital for owners, we are rewarded with only a fraction of it in the form of wages. There are exceptions – imperialist countries sustain bloated middle classes who earn a tidy sum. But they are nonetheless part of this class-wide alienation from the production process.
Furthermore, like Frankenstein’s monster, the products of our labour come back to haunt us as commodities. Commodities take on an almost mystical power over us, as representations of our status and worth. Our labour-power itself is sold to capitalists in return for a wage. Moreover, the requirement for capitalism to expand continually finds new things to commodify – further aspects of our humanity, our emotional labour, romance, spirituality, rebellion, even kindness. And commodities more and more take the place of workers’ humanity: everyone has met someone who names and anthropomorphises their car, gives it a personality and so on. Legally, even corporations are treated as people. And our mental illnesses themselves are commodified and provide big business for the pharmaceutical industry.
Commodities are mobilised by a huge ideological attack on the working class via advertising, marketing, media and education. This is a mass gaslighting project to shape our identity as consumers, induce an empty hedonism in place of community, to value ourselves and each other by the expense and choice of the things we buy, to want more things and new things all the time and thus replacing our self-produced desires with those of big business. Thus we come to assess our worth and others via soulless products and base our self-esteem on things which are to all intents and purposes unattainable: the possibility of changing our class position is about as much as winning the lottery. For the vast, vast majority of us, the class we’re born into is the one we die in – it takes an enormous industry, including Hollywood, Fleet Street, Madison Avenue and our education system, to convince us that ‘meritocracy’ is a reality or that the American Dream is within our grasp.
Class-based detriments to mental health are compounded in Britain by structural racism. State-level racial violence, from police brutality to immigration controls and arbitrary deportations, as well as employment discrimination, make life for people of colour even more precarious. The high reported levels of mental illness among BAME (Black, Asian and minority ethnic) people has not been met with any adequate response from the government. Instead, people of colour suffer from racist discrimination in healthcare provision. Yet in its gaslighting project the media inverts predator and prey and pits groups of workers against each other. Though it would be overly simplistic to analyse racism as a mere ideological “trick”, the media exacerbates divisions in the working-class, positing white workers as ‘victims’ of migrant workers, while landlords are portrayed as the victims of tenants and ‘squatters’, businesses are the victim of strikes, and so on.
With clever use of language and symbols adverts impose identities upon hapless consumers – in the same way a shout of ‘stop!’ from the police in that instant fixes you the target as ‘accused’ or ‘potentially criminal’, adverts make all kinds of derogatory assumptions about us: you’re fat and need to lose weight, you smell bad and need to deodorise, you’re ugly and need to wear attractive clothes, and so on. This not only applies to attire – almost all commodities are sold in this way. You are inadequate unless you buy this particular product. This sense of inadequacy often manifests in a widespread ‘imposter syndrome’ experienced in the workplace.
Huge amounts of money and effort are pumped into the media and culture industries because they are extremely effective at poisoning the working class with self-destructive ideologies. Our society is drenched in white supremacy, ableism, patriarchy, heterosexism and classism. The entrepreneur is seen as a hero for risking becoming a worker like everyone else. The unattainable lifestyles of the rich and famous are glossed and celebrated. As buyers we’re encouraged to envy, and as sellers (for example, in job interviews and on CVs) to boast. We’re told that success requires greed, selfishness, vanity and ruthlessness. Friendship, love and family are subordinate to ‘doing whatever it takes’. And then we’re shamed and ridiculed for our status as working class. The media stirs up moral panics about ‘chavs’ and ‘benefit cheats’. We’re taught to despise ourselves for not winning a game which is rigged against us.
Thus we’re caught in a maelstrom of cyclical crises and precarity, in a gladiatorial arena rigged against us where losing means poverty and even death, being crushed between stagnant wages and rising costs, under constant pressure and surveillance to overwork ourselves, consigned to the meaninglessness of producing for profit, powerless to contribute to running things, dehumanised and reduced to mere tools, browbeaten in a hyper-macho militaristic atmosphere, abandoned in an atomised ‘uncommunity’, and gaslighted by media into fetishising commodities and depending on expensive objects for self-esteem.
All of this would be mere hand-wringing if there weren’t an alternative on offer. Imagine a society where women and girls don’t need to starve themselves through anxiety about their weight and appearance, where they aren’t reduced to sex objects for male gratification, and where patriarchy and the gender binary don’t push women into a position of dependence on men which causes them to have to tolerate long-term emotional or physical abuse. Imagine if housing were accessible to all (as it is in Cuba, for example), there would be an immediate escape route. Imagine a society where there is universal provision of childcare so that women would no longer be at a disadvantage in the workplace.
The economy does not need to be based on profit, controlled by a tiny minority to the detriment of the masses. We can organise society based on human need to eliminate poverty and bring about a new historical era of abundance. We can have universal mental healthcare provision and not be fobbed off with 6‑week CBT courses. We can have an education system that caters to our needs, rather than shoving square pegs in round holes, treating working class children as if they’re in a human zoo, and reducing us all to our function in an economy which is fundamentally against our interests. We can dismantle systems of white supremacy, patriarchy, heterosexism and ableism. We have the technology, we have the resources, we have the know-how – we just need to implement it.