Mental Health and Neoliberalism
Mental Health and Neoliberalism
Mental health and wellbeing are now major concerns for government and big business, as stress, depression and anxiety become widespread in modern societies. But their focus is often solely on the attitude of the individual, which ignores the particular social and economic causes behind such conditions. Here, I discuss with William Davies the psychological demands and effects of neoliberalism and the science of happiness.
William Davies is a Reader in Political Economy at Goldsmiths, University of London. He is author of The Limits of Neoliberalism: Authority, Sovereignty & the Logic of Competition (Sage, 2016) and The Happiness Industry: How the Government & Big Business Sold Us Wellbeing (Verso, 2015). His writing is at www.williamdavies.blog
Historically, most social formations have involved widespread inequality and poverty, and have placed many people under mental stress. It may therefore seem likely that people would experience anxieties and depressive feelings less now, given the relative ease of modern life. So, what is it that makes mental well-being such a prominent matter today? Is it simply that we understand and diagnose mental health issues much more clearly and efficiently now, or are these issues actually more prevalent?
William Davies: Clearly diagnostics techniques exert an influence over the thing they diagnose, meaning that symptoms present themselves differently in different eras, especially where there is a psychological dimension. It is true that the vocabulary and techniques for diagnosing and experiencing depression, anxiety and post-traumatic stress disorder in particular have grown since the 1970s, and that this must be considered a factor in their current levels in Western societies. There isn’t some underlying ‘truth’ about distress, that exists entirely independently of the concepts and metrics society introduces for representing and managing it.
On the other hand, the question of why there is so much distress, represented in this way, must still be asked. This distress is not ‘fake’, even if it is conditioned by its historical and cultural context. I think two things are worth focusing on. Firstly, there is the meritocratic ethos of contemporary capitalism, which states that social class is no longer relevant, and therefore everybody ends up with the socio-economic position they deserve. This produces a chronic sense of self-blame, unease, anxiety and self-recrimination, with individuals having nobody to blame but themselves for not being famous, very rich or more attractive. Combine with digital tools that allow all time and space to be used productively, and you have a society without any sanctuaries from economic competition. This, incidentally, is partly why the phenomenon of ‘safe spaces’ is necessary, providing the possibility of being somewhere where vulnerability is accepted, and also why such a phenomenon attracts so much rage from those of an older generation not privy to them.
Secondly, we live in a time of psycho-somatic confusion, no longer knowing what to attribute to the ‘mind’ and what to the ‘body’, with the ‘brain’ serving as a medium between the two. A great deal of mental illness, as discussed and encountered today, hovers in a psycho-somatic space which is existential but also medical at the same time. The medical dimension stems partly from the fact that psychiatry has become increasingly medicalised since the 1970s, and more dependent on pharmaceuticals, but also from the fact that the medical doctor is one of the last experts that we truly trust, and – in Britain – the NHS is one of the last public institutions of all-round care and sympathy. So we turn in these directions in search of those things, as much as because of physical ailments.
Mental well-being is often presented in terms of blocking out negative influences, learning to accept life problems, and seeing unhappiness as an issue of attitude, or medically as an imbalance in brain chemistry to be treated with drugs. What are some of the political and ideological effects of such understanding?
WD: There’s been a rising sense, since the 1960s, that health is the opposite of pain and unhappiness, which is a very strange philosophy. It is entirely at odds with the psychoanalytic tradition, which views unhappiness as a normal feature of being human, and with the history of medicine which has viewed pain as a healthy therapeutic property of the body. One effect of this shift is to pass responsibility for mental wellbeing towards the individual, giving them techniques and drugs to address their own unhappiness, which is also a way to avoid hearing about it (whether in a psychoanalytic or political setting).
Another is to produce a model of mind and body more suited to the post-industrial workplace, in which positivity and energy are viewed as the source of economic value. Amongst the most worrying practical effects in the UK has been the incorporation of positive thinking into workfare programs, with benefit claimants being told that their negative attitude is the reason they are unemployed, and they must therefore overcome that using various cognitive and behavioural techniques. This, and other examples, produce an ideology in which the social world is a fixed set of institutions, no matter how unjust, but the psychic-emotional world is sufficiently malleable as to compensate for that. Problems and solutions are therefore all within the individual but also within the power of the individual, producing a curious form of optimism that is all about learning to think, feel and behave differently.
In The Happiness Industry, you are concerned with how scientific methods to measure happiness treat people purely as biological bodies, rather than subjects whose desires and interpretations should be factored in to analysis. You say that, “Maybe this scientific view of the mind, as a mechanical or organic object, with its own behaviours and sicknesses to be monitored and measured, is not so much the solution to our ills, but among the deeper cultural causes.” Is this a criticism of science itself, in the way its logic inevitably aims to interpret phenomena in terms of measurable features, or more a criticism of a particular use of science for certain interests? Could such scientific methods be repurposed to treat happiness as a more social issue?
WD: My argument is certainly not with ‘science’ as such! There have been various scientific traditions over the past 150 years which support and endorse a more social and political approach to mental distress and human flourishing (or with a broader understanding of ‘science’, you could go back to Aristotle). I think that cognitivist and behaviourist traditions, both of which have a tendency to rely on mechanistic metaphors of simple cause and effect, have attained the power they do because they are more compatible with dominant economic notions of risk, productivity, customer satisfaction, health and so on. They are very useful, for those seeking to improve workplaces, communities and fiscal balances (because they offer cheap policy solutions, in comparison to more engaged forms of care and therapy).
But there are rival traditions, such as social epidemiology, which shows how inequality, economic institutions and public institutions generate distinctive forms of distress; psychoanalysis, which rests on an assumption of inevitable psychic and social conflict, rather than of optimisation; some clinical psychology and anti-psychiatry, which push back against the medical model, and show how even quite severe mental illness can be understood and treated in terms of social and environmental factors. So, yes, we need knowledge of wellbeing, but this doesn’t have to mean an emphasis on brain, behaviour and ‘attitude’ as the explanation.
Given the huge financial costs of absenteeism and demotivation in the workplace, businesses often place importance on improving the happiness of their employees. Of course, the primary motivation here is productivity and profit, but do the kinds of interventions businesses use (from creating relaxing working environments to promoting more positive attitudes or healthy lifestyle adjustments) actually have anything to do with happiness at all? Do such measures not rather aim at a kind of pressure to outwardly express the right attitude and keep working, regardless of inner feelings?
WD: I think it depends on the type of workplace and work. There are situations where the employer’s main objective is to manufacture a form of outward positivity, for purposes of customer service. Examples of this are found in coffee chains and call centres, where employees are quite closely trained and supervised to adopt positive behaviours, such as smiles, generosity and happy tone of voice, but where there is relatively little interest in their broader wellbeing. The landmark study of this was Arlie Russell Hochschild’s The Managed Heart, which studied airline stewards in the late 1970s, giving a glimpse of the post-Fordist workplace that was emerging at the time. At the other end of the spectrum there are employers such as Google, which provide a remarkable range of benefits, luxuries and free services, to support the employee physically, emotionally and socially, with benefits for their families and pets as well. This is partly to attract the best employees from the global ‘talent pool’, but especially to retain them and attain their complete commitment. It is hard to be unhappy or alienated in such an environment, but it can also be hard to ever leave, as the ‘campus’ model of the Silicon Valley workplaces deliberately encourages. This penetrates much further into the inner psychic and physiological world of the employee. Many workplaces are somewhere between the poles of call centre and Google campus, while there are of course plenty which simply don’t care about the emotional side of work because work is primarily physical and mechanistic.
Is any of this ‘real’ happiness? Of course it has to involve aspects of happiness in order to succeed. I don’t believe it’s false or inauthentic in itself, but it is limited and it does involve power relations. It can produce its own feeling of ennui, as the monochrome, repetitive and somewhat obligatory nature of the happiness starts to become more apparent. But it’s also important not to romanticise Taylorist work practices, which left people alone emotionally, but also cause(d) physical exhaustion, sickness and fatal accidents.
Neoliberal philosophy places self-interest at the centre of human nature, and connects freedom to competitive self-actualisation, which seems to create two contradictory ideas – that the strongest win at the expense of others, and that anybody is free to compete and ‘make it’, if they have the correct attitude and application. To what extent is this contradiction central to mental health issues in today’s societies?
WD: There is an obvious flaw in neoliberalism, which doesn’t just appear at the level of the individual, but also the city, nation, school or university, namely that it views ‘excellence’ and ‘winning’ as the mark of value. But this implies that being normal, average (let alone below average or ‘sub-normal’) is to be without value. The majority of people, institutions and spaces are eliminated via competition, and found to be too weak to excel. Moreover, because it was a competition that revealed this – and not, say, tradition or the power of class stratification – they have only themselves to blame.
This problem becomes more acute over time, as winner-take-all effects take over, and – as Thomas Piketty’s work shows – the returns to capital allow for ‘winners’ to accumulate advantages at an exponential rate. Spatially this is apparent in how places such as London become more and more separate from the rest of their surrounding national territory.
This culture is disastrous for mental health, producing dynamics of depression and anxiety, that every moment of time and every spare resource should be exploited for purposes of greater self-actualisation. The mentality that is pushed towards benefit claimants, that they could be more responsible for themselves if they simply aimed higher – pervades other tiers of social advantage as well, including people who are comparatively well-off. There is a still-rising mental health crisis amongst students, manifest in widespread chronic anxiety, brought on by a sense that time is ticking away too quickly, and one is about to be left behind at any moment. The fact that neoliberalism has in fact acquired intergenerational oligarchic economic structures, in which personal effort is not typically enough to make it or to flourish, isn’t enough to alleviate this vicious circle of self-blame and anxiety.
It seems that modern technology puts a lot of control over people in the hands of the wealthy elite. State institutions can treat deficiencies in happiness as ‘faults’ in individuals that should be treated, while corporations can gather large amounts of data on individuals and groups so as to target their desires or direct them towards certain kinds of information. Does the sheer scope and invisibility of this technology itself produce a kind of inferiority complex among us, so it is even a form of relief to resign ourselves to its demands, rather than confront the task of changing power structures? What kind of individual and collective adjustments may be necessary to help us to escape some of this control?
WD: Individually, we of course need to learn how to disconnect better. Unfortunately this is often through other forms of self-discipline, many of which are also co-opted by digital capitalism, such as sleeping, digital detoxing, meditating and so on. Smart phones will surely go down as a historic moment in the expansion of digital surveillance and tracking, vastly expanding the range of activities and thoughts that are digitally captured and mediated, all within two or three years.
Institutionally, we would probably be better if certain services and products were simply switched off. We should be honest about the fact that, if ever Facebook were under democratic control, the best thing to do with it would probably be to close it down. This is true for psychological, social and political reasons. We should defend and expand non-surveilled spaces and periods of time, although unfortunately that agenda tends to be a somewhat hipster and/or bourgeois one, of hippy parents wanting their children free from screens and theatre goers tutting phones going off. But the principle is right, and could be pushed further for people’s mental health benefit.
On the broader point, clearly the capacity to monitor and influence our feelings is very great indeed. But it isn’t absolute. There’s still something relatively stupid about much of how Silicon Valley and managerial infrastructures seek to deal with emotions, and we should avoid exaggerating their power. There are plenty of utopian propositions out there, of socialising ownership of platforms to creating new platforms and co-operative governance systems, but we also need to challenge the quasi-military emphasis on control itself, not only the political economy that underlies it. I’m not optimistic about any of this, but on the other hand, we shouldn’t underestimate people’s capacity to adapt and achieve new spaces and activities that can’t be very well captured or understood by managerial control systems.
The rise in political alternatives to the ‘centrist’ neoliberal orthodoxy since the economic crisis of 2008 suggests that people do not merely absorb its scientific rationalisation of politics and society. Yet in many cases the result has been more a turn to the right – traditionalism, nationalism, xenophobia – than to the left, which often continues to valorise concepts of self-actualisation through hard work. You also highlight how, rather than viewing people in terms of ideology based on ‘false consciousness’, “it may now be more radical to highlight precisely the ways in which ordinary people do know what they’re doing, can make sense of their lives, are clear about their interests.” But again it seems that these interests are heavily influenced by consumerist ideals promoted by businesses and institutions. So, for example, “Advertising is among the most powerful techniques of mass behavioural manipulation, since it first became ‘scientific’ at the dawn of the twentieth century.” Does it not seem then that people’s conscious desires are still framed by the individualistic, consumerist, narcissistic goals of neoliberalism? If not, is the implication that people are not so heavily manipulated after all, and that they conform to social expectations for other reasons?
WD: The neoliberal paradigm is obviously in great trouble, but I think the turn to the right is accelerating this crisis. The rise of nationalism is really an appeal to solidarity, albeit of an exclusive, often racist variety. But it is an appeal to something that neoliberal rationality cannot compute, namely forms of belonging, meaning and collectivity that endure and aren’t reducible to individual gain. The vote for Brexit, for example, was anti-utilitarian and, in some ways, anti-individualistic. It was an expression of political desire for something more than economics, though sadly resuscitating unpleasant imperialistic cultural politics, and no doubt delivering serious economic self-harm at the same time. I’m not convinced that the consumerist, optimising, utilitarian mind-set is in great health right now, even if people still view certain aspects of their lives through that lens. The absurdity of the situation is that you can play the neoliberal game to perfection, and still end up with very little in return, especially if you were born in the 1990s. So there is a growing mass of people who view competition as punitive, even if they also view it as unavoidable. But that is a major problem for the legitimacy of the system.
Change will come, whether for better or worse, primarily for generational reasons, as we are seeing in various elections at the moment. I don’t doubt that the forms of narcissism and consumerism are still there, but their negative side-effects and moral emptiness seems more apparent than at any point since the 1970s. So there is a cultural crisis as much as an economic one. The problem is that this is also the context that fascism thrives in, with its own seductive promise of solidarity.