Mental Health Resistance Network‎ (via facebook: see details of protest planned for Wednesday 20 November)

Resistance not resilience: ruling class and radical approaches to mental health

To take advantage of the ‘mental health moment’ we need to move away from individualised analyses of mental health, argues Kate Bradley. While employers want healthy workers, they are not prepared to look at the deeper causes of mental distress.

Recently in my workplace, I happened across a poster on the wall written by a company called Validium. The poster was titled ‘Happiness in Action’, and suggested that I could improve my mental health by taking walks in nature, or engaging in some light ‘self-care’. I was annoyed, but struggled to pinpoint why: surely I should be glad that my employer had resources about mental health? And isn’t taking a walk in nature a nice idea?

But my irritation returned every time I saw the poster lecturing me from the office kitchen cupboard. So I looked the company up. Validium’s tagline is ‘increasing workforce value’, and the website is aimed almost entirely at employers who might want to buy Validium’s services: Employee Assistance Programmes, resources like that patronising poster, and training sessions to improve workforce ‘resilience’. Their website states:

In an ideal world, each and every employee would be able to leave their problems at home and focus 100% on their job.

An EAP is an invaluable tool for any organisation, ensuring that good mental health is promoted and facilitated, as well as minimising the impact of any external distractions on employees’ abilities to function or focus while at work.

The paragraph is clear: “we know you’d rather your work was done by machines than people, but we’re here for you: to make your employees more like machines”. Notice that Validium makes no attempt to say it will help solve or remedy people’s problems – only to make them “leave their problems at home”. People’s lives are “external distractions”, and there’s no recognition of the fact that people’s stresses and anxieties often come from inside their workplace.

The website is baldly honest about Validium’s raison d’être: protecting your company’s profits. “Validium works in partnership with you to ensure that every penny invested pays for itself several times over,” they boast. Amongst Validium’s quoted advocates is Zurich Insurance, who write: “Validium’s clinical expertise has brought about a demonstrable decrease in the time taken to rehabilitate absent employees.” Nationwide Building Society also gave a glowing review: “By working in partnership with Validium we’ve been able to generate a measurable difference to the bottom line.”

Though shockingly out of touch with why I want to improve my mental health, Validium addresses a real worry for employers: the number of days lost to mental health-related employee absence, and the hassle of managing people’s emotions to ensure they’re constantly delivering the intensified work you need to make a profit  (or, in not-for-profits, outcomes for your funders and salaries for your high-paid managers). In 2015/16, according to the Labour Force Survey, there were 0.5 million workers in the UK suffering from work-related stress, depression or anxiety, and stress caused 45% of all working days lost due to ill health. Statistics from Investors In People in 2015 suggested that up to 60% of UK workers were unhappy in their current jobs, and 57% were planning to leave within a year. This tells us why employers are so anxious, but inevitably, their focus is not on the human cost of mental illness, it’s on profit, which skews how they talk about people’s problems.

Big NGOs like the World Health Organisation awkwardly straddle genuine concern for mental health and employer-focused rhetoric, as was glaringly clear in their campaign against depression for World Health Day in 2017. In an incitement to employers and states to increase spending on depression, their campaign video stated that the estimated global economic loss due to depression was US$1 trillion a year. But what is that to do with me? When I’m depressed, I don’t care whether my employer is making money. I don’t want to wait for their charity, especially since their interest is in making me productive, not necessary genuinely happy and enriched.

I’m going to suggest that we begin to distinguish between ‘ruling class’ approaches to mental health – exemplified by Validium, but also the Tories’ and royal family’s inane destigmatisation campaigns – and ‘radical’ approaches, which are based in the messy real-world experience of mental distress and aim to genuinely improve people’s wellbeing and happiness. This difference is crucial, both because it helps us resolve that suspicion and discomfort we may feel at mainstream mental health campaigns, and teaches us how we start to fight for better salves to our collective suffering than these poor approaches offer.

Ruling Class Approaches to Mental Health

At rs21’s Day Without Men 2018, a group of women working in a wide range of workplace environments (including charities, call centres, tech start-ups, schools and the NHS) gathered to chat about the changing nature of work, and all reported the same experience: their workplaces had all made them do ‘resilience training’. The sessions we had experienced were a clumsy patchwork of stress management tips, empty optimism and orders to practice ‘mindfulness’ and self-care in times of stress and anxiety. Resilience training has hijacked the language of self-care – originally a feminist concept to keep people fighting fit, not compliant – and repackaged it to increase workplace productivity.

Once, when I applied for a job with a large third sector organisation, coded questions about mental health and resilience were built into the “personality test” at the start of the process, used to weed out weaker candidates who would presumably not be able to take the burden of increasing stress levels at work (as Jaz Blackwell-Pal has discussed in her writing on ‘emotional labour’). Hazards magazine have pointed out that “employers love concepts like resilience because they are less challenging than preventing stress”. However, talking about resilience can further depress workers by making them feel responsible for their own failure to deal with unreasonable demands – workers internalise “moralising narratives around personal responsibility”, as Felicity Thomas and colleagues argued in an excellent article this year.

Resilience training and its attendant bullshit is reflective of a wider tone of faux-concern about mental health spearheaded by the Conservative Party during the 2017 general election. As part of their manifesto, the Tories promised “real action on mental health”. This is routinely contradicted by their other policies, since it is well-known that programmes and policies put in place by the Tories, not least their ideologically-driven benefits cuts which force people into work, have made life significantly worse for people suffering from mental health problems. To resolve this contradiction, the Tories embrace ways of seeing suffering which source unproductivity in an individual’s failings – either in their brain chemistry or their personality flaws. This fits neatly with the right’s broader tendency to see benefits claimants as undeserving, homeless people as addicts or ingrates, and successful managers and business-owners as having ‘worked their own way up’, denying any structural causes for inequality in society.

Still image from a YouTube video on the Heads Together website

A similar shallow tone can be found in the Heads Together campaign, led by various celebrities including the young royals, which funnels huge amounts of money into “raising awareness” about mental health issues. Heads Together promotes the idea that “opening up conversations” is the key to solving people’s mental health issues. While destigmatisation is valuable – especially for those with neurodivergencies which lead to discrimination, such as people with schizophrenia – it also helps to construct a category of the “mentally ill” person, who is assumed to pre-exist the category and now just needs tolerance and empathy. In its silences, the campaign promotes the idea that all mental health problems are alike, simply an inevitability, rather than, in many cases, being caused and triggered by adverse life conditions. Focusing on causes would soon run the royals into trouble, as they would have to start asking why poverty is correlated with depression, and why it seems to be concentrated in certain societal groups – implying it is not merely natural, but caused and intensified by inequality in society (inequality they cheerfully represent).

Ruling class approaches to mental health assume that making a person “functional” – i.e. able to work and “contribute” again – is the solution to their problems. These approaches are often quite patronising, seeing individuals as just needing counselling or medication to “get back on their feet”, misrecognising material struggles and adverse reactions to general disempowerment as a failure of coping strategies or individuals’ brain chemistry. These are the approaches of government ministers, pharmaceutical companies’ PR departments, and even many doctors. Ruling class approaches systematically attempt to diminish systemic responsibility for these problems and attempt to solve the problem using cheap, short-term fixes to keep people productive – teaching “coping strategies”, dispensing profitable medication, or encouraging people to lean on family members. Together, these approaches create a ruling class ideology of mental health, which filter down through the system and into how all of us talk about our experiences.

We can also see how ruling class declarations on mental health serve as a useful PR exercise. For instance, the main thing most people remember about the Heads Together campaign is that it’s fronted by Prince William and Princess Kate, and so it serves to shore up the royal family’s PR ready for when the Queen dies. (Perhaps the campaign would be better branded as Heads of State Together?) For the Tories, talking about mental health can soften their tarnished public image and ease their reputation for enacting punitive and violent public policies.

The dangers of ruling class approaches to mental health are manifold. Firstly, they only focus attention on mental health issues which negatively impact on profit, meaning they give most energy to the biggest causes of economic ‘loss’, such as depression. This means that they ignore the daily realities of people with either minority mental health issues or neurodivergencies that might actually increase profit at the cost of social cohesion and happiness, e.g. psychopathy, which is shown to be disproportionately represented amongst highly successful professionals. (For example, one study in Australia found that 1 in 5 CEOs met the criteria of a psychopath, associated with competitive and aggressive anti-social behaviour.)

Secondly, since profit is the motivator, these approaches implicitly favour individualised and cheap solutions to mental health issues, such as teaching people to repress and control emotions rather than deal with root causes, or providing low-cost, group-based treatments designed to get people back to work faster, such as Cognitive Behavioural Therapy. These approaches rely on the disciplining factor of people needing to work to pay the bills, so actions like reducing disability benefits for the mentally unwell may be as ‘effective’ at reducing ‘delinquency’ from work as actually helping people to return to health.

Radical Approaches to Mental Health

By contrast, radical approaches to mental health start from the roots of people’s problems to consider why so many people’s experience of life today is so miserable and anxiety-inducing. These approaches can be distinguished from the ruling class approaches in that see people as full human beings, not just malfunctioning economic units. Radical approaches consist of helping people find their own solutions, both individual and collective. A distant end goal of radical approaches is to build a world where people are given their full chance to flourish emotionally, intellectually and artistically. In the long term, this may mean fighting for the automation of work so we don’t have to labour for most of our lives, the abandonment of economic growth as a prime motivator, and free healthcare and housing for all – just as three examples. None of these could be in the vision of a committed capitalist who wants you back at work tomorrow.

So how can we build towards this end goal?

First, I’d suggest that radical approaches necessarily involve moving away from the biomedical model of mental health, as Hazel Croft has written about very eloquently. Croft talks about the “pathologisation of everyday life”, arguing that the interests of big pharmaceuticals companies and the psychiatric industry have come to dictate what research is done on mental health problems and how it is applied to patients. Instead, she argues for a “social framework”:

A social framework allows us to see how mental health is central to every aspect of our lives, and connected to all the battles we face – against racism and sexism, for sexual liberation, for decent housing, or in our struggles in the workplace against precarious work and attempts to make us work longer and harder. Our struggle is alongside mental health workers, service users and others. Yes, to defend services when we must, but also to envisage how we could conceptualise mental health in a liberatory way that doesn’t reduce us to our biological bodies or view us as units to be measured against happiness scales.

This social framework demands that we get a bit more sceptical about the biological and individualised analyses of mental health to which we have become accustomed in recent decades. It also teaches that many mental health ‘problems’ would not be problems in a more caring and inclusive world. For example, an extreme intolerance for depression as unproductivity has arisen with the totalisation of capitalism, but existential suffering may cause a less acute personal crisis if we didn’t have to get up for work every day (we might even experience less of it). Instead of simply accepting the medical labels we are given, which become reified by their scientific gloss, we should always question whether we are the problem – or whether the world around us could be altered to better accommodate us.

Nevertheless, even in a perfect society, there will likely be many occasions on which people do feel they need a label to be understood, to articulate their needs and to establish and access relevant support. However, that support does not always need to be clinical. For many of us, emotional care is better when it comes from those who are close to us, from our friends, relatives and social networks. To get to a point where we can give this community care, we must fight for an abundance of time, energy and health for everyone – therefore better pay, shorter work days, and more spaces in which we can build community between people.

When we no longer see mental health care as merely a medical concern, it also becomes clear that we’re talking about much more than funding charities like Mind or the NHS. Although opposing cuts to the NHS and services is crucial, many of these services are administered by the state and big NGOs. As a result, they are at best ambivalent to the social good, since they’re designed to mediate between the interests of people and capital. Setting up and finding new models of funding  for healthcare collectives, free social services and peer support groups could be one radical approach. We can also try to make our political spaces as inclusive and supportive as possible, a fluffy-sounding proposition but incredibly valuable when helping people deal with suffering in a way which doesn’t atomise them.

In our trade unions, too, we should take heed of the ‘mental health moment’ in the media, but not let ourselves get swept along with the insidious tone of mainstream mental health campaigns. Primarily, this may involve indexing demands around improving mental health to campaigns for better working conditions, pay and hours. Our happiness is embedded in our social lives and our material conditions, in and outside of work, and so unions should avoid the vacuous language of ruling class mental health campaigns. Unions could also offer alternative routes to mental health care, both by defending NHS services, and by expanding their own resources. Done well, this could ensure that mental health care does not have to be administered (and therefore ideologically managed) by an employer or the government.

For radicals of all stripes, the end goal of mental health care should be the same as our other aims: collective freedom, not personal placation with the status quo. This necessarily means digging deeper into the causes of mental distress than your employer and the Tories will ever be willing to go.