Psychiatric Hegemony: A Marxist Theory of Mental Illness


Many books expose psychiatry’s crimes against humanity. However, few analyze psychiatry in relation to capitalism, and even fewer attempt this with a marxist analysis.

In Psychiatric Hegemony: A Marxist Theory of Mental Illness, Bruce Cohen breaks new ground. He explains the expanding power and influence of psychiatry in terms of its usefulness to the capitalist system — the more useful it is, the more power it is given, and the greater its power, the more useful it becomes. More specifically, he analyzes DSM-1 through DSM-5 to show how psychiatry has supported capitalism’s neoliberal transition, gaining power and prestige in the process.

A professor of sociology at the University of Auckland, New Zealand, Cohen informs us that

the current discussion is a critique of professional power not of personal experience and behaviour which may have been labelled (or self-labelled) as a ‘mental illness.’ (p.3)

His target is the ‘mental health industry’ which includes “the entirety of the professionals, businesses, and discourse surrounding the area of mental health and illness.” He labels all who work in this industry as ‘psy-professionals’ whose function is to “normalise the fundamental inequalities in capitalist society as natural and common sense.”

Psychiatric Hegemony

Cohen challenges the theory that the pharmaceutical industry’s lust for profit is the primary driver for psychiatry’s increasing authority or ‘hegemony’ over society. He also disputes the claim that growing inequality and loss of social support are causing more people to become ‘mentally ill.’ Instead, he applies the marxist method to reveal how psychiatry serves the capitalist system. To summarize his argument:

The capitalist class seeks to avoid responsibility for the many problems it causes, so it frames pain and suffering as somehow natural and inevitable. Psychiatry supports capitalism by ‘diagnosing’ socially-created problems as individual cognitive or biological defects, providing pseudoscientific ‘evidence’ for blaming the victims of the system. To use Erving Goffman’s metaphor,1 if capitalism is a con game, then the role of psychiatry is to ‘cool the losers’ of the system so they don’t squawk, expose the con, and take their revenge.

While suffering may well be increasing, we are mistaken to label it ‘mental illness.’ Warnings about the ‘growing epidemic of mental illness’ followed by calls for more access to ‘treatment’ testify to psychiatry’s success in framing an expanding number of social problems as medical in origin. Psychiatric hegemony results when the medicalization of suffering has penetrated every aspect of society, to the point that sufferers ‘diagnose’ themselves and each other.

Through psychiatric hegemony, then, we are all implicated as ‘at risk’ of mental illness and must constantly self-monitor for potential signs of disorder. (p.90)

The pharmaceutical industry plays an important but secondary role. Pharma enhances the credibility of psychiatry as a medical (prescribing) profession, which increases its usefulness to capitalism.

The predominance of drug interventions does benefit capitalism directly by reducing the need for more expensive institutional ‘care.’ Also, chemical forms of social control are more subtle and raise fewer objections than physical constraint as a means to manage social deviance. However, psychiatric drugs would have no currency without the power of psychiatry to prescribe them as ‘treatment.’

Cohen’s textual analysis of the DSM, from 1952 through 2013, reveals the increasing extent to which psychiatry has positioned itself as an authority on ‘acceptable behavior’ at work, at school, at home, and in personal life — acceptable behavior being defined by what benefits capitalism.

Whereas the DSM-I and the DSM-II make hardly any reference to such arenas of life, the DSM-III dramatically increases such phrasing — a trend which continues as neoliberalism progresses. (p.79)

Work: Enforcing Compliance

Cohen explains how psychiatry frames ‘under-performance’ at work as an individual ‘mental illness’ requiring ‘treatment.’

psychiatry and allied psychological sciences have expanded their areas of jurisdiction into the workplace of the white-collar worker at the behest of capitalist enterprise, where self-surveillance and a continual working on the self have become a part of the increased need for an efficient, flexible, and mobile labour force. (p.98)

He documents how work-related terminology increases in each edition of the DSM, from 10 mentions in DSM-1 to almost 40 times that number in DSM-5, with a significant jump between DSM-2 and DSM-3. By focusing on individual performance, psychiatry depoliticizes workplace conflict.

instead of recognising power disparities in the work environment, new and/or changing diagnostic categories of mental illness encourage workers to problematise the self rather than the organisation or wider society. p.104

An expanding service sector requires workers who are sociable go-getters who can sell products and services. Those who are quiet, withdrawn, or shy are disadvantaged. Quoting Ron Roberts, “It is no longer enough just to shift product, one must now do it with a smile, with ‘sincerity,’ with a friendly touch,”2 Cohen concludes:

the pathologisation of shyness reflects neoliberal capital’s desire for ‘emotional labour’ within the work force. (p.109)

To better “align their ‘expertise’ and ‘science’ with the needs of capitalism,” psychiatry adds Social Phobia and then Social Anxiety Disorder to the DSM.

since the original construction of social phobia in 1980, workers have become more inclined to self-label and entertain the possibility of therapy and drug treatment for their failure to be more sociable and assertive at their place of work. This situation has further legitimated the extension of the psy-professions in the areas of unemployment, job training, and work, reinforcing the neoliberal focus on the self as the site of change, while simultaneously depoliticising the increasingly alienating work environment and constant pressures on employees to upskill and be ‘more employable’ in the jobs market. (p.108)

The ‘mental health industry’ has penetrated the workplace to the extent that, in 2014, the Bureau of Labor Statistics ranked industrial psychologist as the fastest-growing occupation in the United States.

Youth: Medicalizing Deviance

In this chapter, Cohen reveals how

the increasing infiltration of the psychiatric discourse into the education system serves a significant function for capitalism in enforcing dominant moral codes and economic prerogatives while pathologising any deviation or resistance to these patterns of authority. (p.113)

He points out that “just a hundred years ago cases of mental disorder in children were considered most rare, with there being no specific pathology that psychiatry believed affected young people in particular.” Today, millions of American children are prescribed psychiatric drugs for a growing number of ‘mental disorders.’

Cohen explains this shift by noting that neoliberalism demands greater social control, and psychological testing in the school system is a way to identify and pathologize non-conformists.

As a result of the pressures on teachers and pupils in this neoliberal environment, there has been a need for a closer surveillance of behaviour in school and, more readily, a desire to discipline the defiant child through the application of various mental illness labels. (p.127)

The expansion of psychological testing in schools contributes to the growth of the ‘mental health industry,’ making it more useful to the system.

The psychological sciences have become increasingly useful for teachers and the schools system in supporting the exclusion of troublesome pupils and labelling non-conformist students as mentally disturbed. (p.126)

From its very first edition, the DSM has linked unwanted behavior and conduct in the classroom to childhood ‘mental illness.’ Cohen recounts the shameful history of pathologizing school-age children who do not conform, from the label of “moral imbecile” at the start of the 20th century, through EL (encephalitis lethargica) or “sleepy sickness” in the 1920s, to ‘hyperkinesis’ in the 1950s to ‘minimal brain dysfunction’ in the 1970s, to ADHD today.

Clear within the phraseology and the “symptoms” of ADHD is the concern to medicalise the behaviour of unruly children in the classroom…and, therefore, the APA developing the label of ADHD as a device of social control. (p.129)

Cohen’s analysis reveals that the number of youth-related diagnostic categories rose from 8 in DSM-1 to 47 in DSM-5. More remarkable is the dramatic rise in the number of youth-related words or phrases from 45 in DSM-1 to 1,983 in DSM-5 with a particularly steep rise between DSM-2 (112) and DSM-3 (1024). Cohen explains,

the DSM-III and the growing focus on youth mental illness can be understood as a consequence of the deinstitutionalisation of deviant youth from special education facilities. (p.124)

As tighter school budgets eliminate engaging programs and activities, it becomes more difficult to hold students’ attention. Correspondingly,

With the construction and expansion of the ADHD category to greater numbers of young people, the emphasis is changing from overt disruption to student inattention. (p.133)

Women: Reproducing Oppression

In this chapter, Cohen shows how psychiatry polices the behavior of women in ways that adapt to the changing needs of capitalism.

The wrenching transition from a rural peasant economy to an urban industrial one was particularly difficult for working women. Initially incorporated into industry, they were later excluded by ‘protective’ legislation. Restricting women’s role to reproductive work in the home effectively assigned them to the status of second-class citizens.

Psychiatrists become increasingly important throughout the industrial period as initially incarcerators of deviant working-class women and then as moral enforcers of gender roles, “respectable femininity,” and the sanctity of the family. In this way, the institution of psychiatry takes over the moral role previously performed by religion in feudal society. (p.142)

Psychiatry provided ‘medical’ justifications for women’s oppression. Pseudoscientific theories about women’s ‘weaker’ minds were used to justify keeping women at home and discriminating against them at work.

Women who protested the prescribed female role of submissive wife and daughter, doting mother, and eager housekeeper became targets for compulsory hospitalization, mutilating surgery, and other punitive measures in the guise of ‘treatment.’

In Victorian society, drinking, dancing, or even having a political opinion were all potential grounds for psychiatric incarceration. The confinement of these mainly working-class women in asylum becomes the backbone of institutional and scientific development of the psychiatric discipline, and the over-representation in asylums then provides justification for its focus on mental disease as a distinctive “female malady.” (p.142-3)

Cohen’s analysis of the DSM reveals how the number of ‘feminised’ diagnostic categories rose from 4 in DSM-1 to 24 in DSM-5 with, yet again, a significant jump between DSM-2 and DSM-3.

Today, more women are in waged work than ever before, in effect, challenging the ‘female role.’ To contain that challenge, the number of gender-related words/phrases found in the DSM rises from 105 in DSM-1 to an astonishing 3,096 in DSM-5.

The total count increase witnessed with DSM-III, DSM-IV, and DSM-5 is evidence of the increasing usefulness of psychiatric discourse as a means of ideological control of female behaviour, both policing the boundaries of acceptable gender roles as well as reinforcing heteronormativity. (p.154)

He concludes,

psychiatric hegemony serves to depoliticise the reality of women’s experiences through recasting patriarchal and capitalist oppression as personal distress and individual pathology. (p.149)

Resistance: Pathologizing Dissent

The use of psychiatry to pathologize protest is well-documented.

As a supporting institution of capital the role of the mental health system is to delegitimise such political action as signs of irrationality, dangerousness, and mental pathology rather than a rational and logical consequence of widening social and economic disparities within western society. (p.193)

Cohen recounts some of the stomach-turning atrocities of psychiatry, including,

the normalisation of conditions of slavery, the psychiatric incarceration of political activists, the labelling and drugging of young people with school related “disorders,” the lobotomising of problematic wives, the torture of war combatants, the castration of working class men and women, the pathologisation of the unemployed, and the mass murder of psychiatric inmates. (p.206)

Cohen shows how the number of protest-related words/phrases rose from 11 in DSM-1 to 201 in DSM-5, with two significant jumps: one between DSM-2 (11) and DSM-3 (80); and an even larger jump between DSM-4TR (63) and DSM-5 (201). Of particular note is the increased use of the terms ‘delusions of persecution’ or ‘paranoia,’ from 3 in DSM-4TR to 14 in DSM-5, and a corresponding increase in references to ‘violence’ from 43 to 148. As Cohen points out,

The irony of psy-professions’ focus on political violence as symptoms of pathology is the denial of their own involvement in inflicting systematic institutional violence on others… a contemporary case in point is the American Psychological Association’s involvement in the torture of detainees at US military prisons at Abu Ghraib and Guantanamo Bay. (p.196)

This service is amply rewarded by the capitalist State.

the psy-professions have increased their professional capital and power through promoting a psychiatric discourse which serves to incarcerate, torture, and murder political opposition and deviant groups under the rhetoric of “medical progress” and “acting in the best interests of the patient.” (p.200)

Challenging Psychiatry

In his concluding chapter, Cohen states, “the mental health system is a fundamentally political project” whose priority is not the mental health of the population but social control.

I have drawn on extensive evidence to argue that the psy-professions were created and progressed to regulate and manage western populations through personalising social and economic issues, pathologising political dissent, policing and punishing problematic and deviant groups, and reproducing the dominant norms and values of the ruling elite through psychiatric discourse. (p.205)

However, when it comes to solutions, the book flounders.

Cohen links “the ‘crisis’ of psychiatry in the mid-1970s, the construction of the DSM-III in 1980, and the wider development of neoliberal policies.” (p.70)

psychiatric discourse becomes increasingly important in reinforcing the dominant goals of neoliberalism, focusing on the self — rather than the group, community, organisation, or society — as the appropriate site for change and ‘growth.’ (p.76)

the psychiatric discourse witnessed in the DSM-III (as well as subsequent DSMs) reflects the emergence of neoliberal obsessions with efficiency, productivity, and consumption. (p.79)

By the time of the DSM-5, psychiatric diagnoses are blatantly mirroring neoliberal ideology in relating mental illness to under-performance.” (p.80)

Psychiatric labels increasingly “focus on deficits and failings in character which threaten the productivity and consumption activities of the individual in many social and economic arenas of life. (p.87)

Cohen stresses that “the recent demands of neoliberal capital have necessitated the expansion of the psychiatric discourse to the point where it has become hegemonic and totalising.” (p.70) However, he does not explain why neoliberalism needs to exert so much control.


The capitalist class embraced neoliberalism to counter a social and economic threat. The mass rebellions of the 1960s and 70s had helped to defeat the US in Vietnam, demolished the presidency of Richard Nixon, and were demanding higher living standards and greater corporate accountability. Psychiatry also came under siege as activists forced the removal of homosexuality from the DSM and campaigned against the inclusion of gendered ‘diagnoses’ like Self-Defeating (Masochistic) Personality Disorder and Pre-Menstrual Dysphoric Disorder.3 Add to all this an economic recession and a falling rate of profit.

Neoliberal policies aim to boost the rate of profit through deregulation, cutting social programs, transferring public assets and services to the private sector, lowering corporate taxes, and gutting unions. To support these policies, neoliberalism exalts individualism — the claim that social programs promote laziness and reduce productivity, that no one is entitled to anything, that one should work for what one has, and that too many people are ‘freeloaders.’

People naturally resist deteriorating living conditions, so coercion becomes more important. The penal system manages the law-breakers, and psychiatry manages the rule-breakers. Both institutions have expanded tremendously since the mid-1970s.


Why does Cohen not acknowledge that psychiatric hegemony developed in order to counter popular revolt? Strange as it may seem, some marxists believe that the victory of the working class over capitalism is ‘inevitable’ or ‘destined.’ In Cohen’s words,

Given the oppressive economic conditions that workers endure under capitalism, Marx prophesied the proletariat revolution as inevitable. (p.71)

Ultimately, [capitalism] is a system defined by the permanent struggle between the proletariat and the bourgeoisie over the means of production — a conflict which the workers are destined to win… (p.30)

Religious concepts like ‘inevitable’ and ‘destined’ have nothing to do with genuine marxism. Marx never ‘prophesied,’ because the outcome of struggle cannot be guaranteed. He stated that the working class has the power to defeat capitalism; however the outcome could also be “the common ruin of the contending classes.”4 This could happen through war or environmental destruction. Marx emphasized that what happens in the future depends on the choices we make today.

Cohen believes that the defeat of capitalism is assured, so he does not concern himself with the class struggle but on what can be done ‘in the meantime.’

My Marxist argument necessarily entails the end of capitalism, yet there is also plenty that can be done to subdue and diminish psy-power before the current economic order finally collapses. (p.207)

Even if it were true that capitalism will eventually collapse of its own accord, why not do everything we can to bring that day closer, to prevent as much suffering as possible?

Cohen’s marxism is mechanical; it has been stripped of all revolutionary dynamic. The heart of marxism is the self-emancipation of the working class, which is now the majority of humanity and the single greatest threat to capitalism. Yet the working class appears in this book only as victim, never as liberator.

Capitalism needs psychiatry to impose social control because it fears working-class revolt. The greater the threat, the greater the need for repression. Cohen sees the repression, but not the potential power of the working class that makes such repression necessary. This leaves him with no workable solution to the problem of psychiatric hegemony.

Class power

Early in the book, Cohen acknowledges class divisions in medicine.

the exploitative work relations within capitalist societies are replicated within the rigid hierarchy of medicine, with high-waged, upper middle-class consultants holding a great amount of decision-making power at the top, the lower middle-class nursing managers administering consultants’ needs in the middle, and — holding no power whatsoever and subject to the whims of health managers — the low-earning working-class orderlies and auxiliary staff at the bottom of the pyramid. (p.32)

If the working class holds “no power whatsoever,” then why the need for repression?

While it appears that workers have no power, this is an illusion. When workers strike, ‘business as usual’ grinds to a halt.5 When workers move into action as a class, they not only have the power to stop producing or serving capital, they can also redesign work, and therefore society, to meet human needs. This is the power that capitalism most fears, the power that can bury it. Cohen does not acknowledge this, and he dismisses the working class as a force for social change.

While (rightly) condemning the ‘mental health industry,’ Cohen (wrongly) condemns everyone who works in it, “not only the psychiatric profession, but also allied groups such as psychologists, counsellors, psychiatric social workers, psychoanalysts, and the many other ‘talk therapy’ professionals,” on the basis that

The psy-professions are not on our side, they have never stood up for us. In fact, quite the reverse. As we have seen in this book, the class interests of the psy-professions closely align with the ruling elites… (p.207)

This is simply untrue. Like all institutions, the ‘mental health industry’ is divided by class, between the few who set policy and the many who carry out orders.

Common interest

While understandable, it is a mistake to counterpose psychiatric survivors and workers in the ‘mental health industry.’

Psy-workers are as vulnerable to psychiatric victimization as any other group of workers, if not more so.6 (2016). Psychiatry interrogated: An institutional ethnography anthology. Palgrave MacMillan.] And a great many psychiatric survivors (or their family members) become counselors and psychotherapists in order to provide better care than they or their loved ones received.7

Many people who work in the psy-industry write, organize, and campaign against psychiatry, including those who blog on websites like Mad in America.

Many psy-workers are sickened by jobs that promise to help, yet too often hurt. Others risk their livelihood to demand that human needs come before profit-making.8

In short, there is a large base of workers in the ‘mental health industry’ whose class interest conflicts with those who decide policy, and this is true of every institution under capitalism.

Capitalism is an all-encompassing system of relationships which means that we are all “implicated in systematically serving the interests of the powerful.” (p.8) All paying jobs serve the capitalism system, even if the people doing those jobs are trying very hard to do something else.

The fact that we all participate in reproducing capitalism every day does not stop people from rebelling. On the contrary, it promotes rebellion, because our best instincts as human beings are repeatedly violated by the work we are expected to do to serve a brutal and brutalizing system.

Cohen is correct that most psy-workers are bamboozled about the value of what they do — believing they are making the world a better place, when they are actually contributing to psychiatric hegemony. Nevertheless, most do not enter the industry to serve as agents of oppression, and when they realize they are, they can become magnificent fighters against it. Marxism calls this a ‘contradiction.’ Institutional Ethnography calls it a ‘disjuncture.’ Psychology calls it ‘cognitive dissonance.’ These conflicts provide openings for consciousness and behavior to change.


Cohen rightly concludes that the institution of psychiatry must be abolished, yet he offers no workable way to do this. Instead of supporting workers to challenge capitalism and psychiatry, he writes them off.

Thus, despite having some psy-professional friends and colleagues whom I continue to work with on various research projects, I would at this stage be a fool to recommend anything other than the wholesale abolition of their profession. (p.208)

How ‘their profession’ would be abolished is never explained. Once the working class is dismissed as a force for social change, the only weapon left is moralism. And moralism has no power to accomplish the goals that Cohen identifies.

Firstly, we must remove psychiatry’s compulsory powers. This includes the power to incarcerate and to enforce shock treatment and drugs — including the use of compulsory treatment orders…Secondly, the prescribing rights of the profession should be withdrawn…thirdly, ECT needs to be outlawed. (p.208-9)

Who will remove psychiatry’s compulsory powers? Who will withdraw psychiatry’s prescribing rights? Who will outlaw ECT? Cohen replies that

This involves the disruption of the psychiatric discourse on many fronts through an alliance of political activists on the left, psychiatric survivors, critical and radical academics and students, and community leaders. (p.207)

These groups have important contributions to make. However, on their own, they do not have the power to defeat capitalism, and psychiatry cannot be abolished without abolishing the system that requires it. As Cohen has shown, the two are organically linked.

A revolutionary working class would have the power to abolish capitalism and psychiatry. In the absence of such a force, one can mount only a moral challenge. Capitalism is more than capable of repelling moral challenges; it enlists psychiatry to label them paranoid.

Psychiatric Hegemony is a valuable contribution to understanding the growing power of psychiatry in general and biological psychiatry in particular. However, it takes us only so far. We need revolutionary marxism to take us the rest of the way. As one psychiatric survivor declared,

To be clear: ‘helping rooms’ [for psychiatric containment] are the problem, not necessarily their employees. I have sat at tables where hospital workers and psychiatric survivors alike acknowledge them as traumatizing, sometimes for both sides. Many psychiatric hospital workers find their work miserable and exhausting, in part because they must act in unnatural, professional (code for distant), and sometimes violent ways towards people. But insofar as staff hold all the power in these rooms, we need them to revolt.9

Show 9 footnotes

  1. Goffman, E. (1952). On cooling the mark out: Some aspects of adaptation to failure. Psychiatry: Journal of Interpersonal Relations, Vol.15, No.4, pp.451-463.–files/19520101-on-cooling/19520101%20On%20cooling.pdf
  2. Roberts, R. (2015). Psychology and capitalism: The manipulation of mind. Alresford: Zero Books.
  3. Caplan, P.J. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. Addison-Wesley.
  4. Marx, K. & Engels, F. (1848). The manifesto of the communist party. Chapter 1.
  5. Rosenthal, R. (2014) Rank and file rebellion: The 1981 Ontario hospital strike. Toronto: ReMarx Publications.
  6. See Chapters 3, 8, & 9 in Burstow, B. [Ed.
  7. Lewis, S. (2015). The skeletons in my closet. TEDx.
  8. Winslow, C. (2015). When workers fight: NUHW wins battle with Kaiser. Beyond Chron, Nov. 24.
  9. Morgan, S. (2016). The helping room. Mad in America, October 27.


  1. I hate to bring this up, but just as the Russians initially beat us into space, they also preceded our entry into coercive psychiatry, in which dissidence is seen as a mental illness, in which treatment consists of turning the dissident into a pliable mental incompetent. Interestingly enough, both these advances took place in Krushchev’s time. That’s what the Serbsky Institute was all about.

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    • Yes, @bcharris, it’s exactly what the Soviets did and what China does today, ‘…turning the dissident into a pliable mental incompetent.’ No indication in the history of communism/marxism/’the left’ that ANY communist state will ever treat people any better. To the contrary, apart from the failures of communism around the world, the regressive-left currently engages in social control by trying to shut all free speech and engage in thought-control through authoritarian political means (current examples in USA, Canada). Not an ideal manner of making people ‘mentally’ healthier, haha.
      Liz Sydney

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      • I know you believe you’re being logical; however your logic is clouded with many misconceptions regarding what is meant by terms such as Marxism, communism, etc. For example, there has never been a “communist state,” nor did the USSR or China ever claim to be such. The term is a contradiction anyway, as “communism” refers to a condition where all states have gone out of existence. Moreover, even socialism — the precursor to such a time — had disappeared from the aforementioned states by the time of the USSR’s dissolution and Mao’s death, respectively; it was overthrown and carried on in name only.

        Socialism is where the 1% is replaced by the 99%, or as close as possible. It involves people being in control of the work they perform and able to enjoy it’s fruits, and a social consensus as to what work is considered valuable. It has nothing to do with Democrats, “progressives,” or whatnot; this false notion of what constitutes the “left” is a product of the corporate media effort to keep people fighting that which is in their own interest, and convincing them that they are doing the opposite.

        As for my reply to bcharris, it is obviously untrue that coercive psychiatry began with the USSR, which, for the record, is the statement I was refuting.

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        • That is a good answer. I was about to offer a similar comment, but was glad to see you beat me to it. Part of capitalist realism is the caricaturing and obfuscation of all alternatives, in order to shut down radical imagination of other possibilities.

          Within the capitalist reality tunnel, it’s irrelevant what is actually meant by socialism, communism, and Marxism. It’s about rhetoric, not substance. But the problems of capitalism that we face are very much of substance.

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      • You wrote, “the regressive-left currently engages in social control by trying to shut all free speech and engage in thought-control through authoritarian political means.”

        Could you give some examples of this?

        When I think of, “authoritarian political means,” I think of military dictatorships locking people up without trail or, “Dissapearing,” people or of torture. While many consider what happened at Gauntanomo, or indeed in USA prisons where solitary confinement is frequently used, as torture I somehow think this is not the sort of thing you are on about.

        So could you please explain your terms?

        Regards John Hoggett

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          • Again, liberals are not leftists. Identity politics and the preoccupation with semantics (which are not unimportant btw) are components of the “academic left,” which it seems to me is to a good degree composed of wannabe 60’s activists, not actual organizers. The old saying “those who can’t do, teach” may apply here.

            Does the bill in question specifically apply to official state business or to people talking to each other in public?

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          • I’m not sure what your point is Rossa. From what I can understand some people want gender free pronouns. Proff Peterson does not like that. It sounds like the gender free people are promoting freedom of speach and the Proff thinks it has gone too far. None of that debate seems to me to be about, “the regressive-left currently engages in social control by trying to shut all free speech and engage in thought-control through authoritarian political means.” It sounds more like politics as normal. It might be irritating if you are on either side of the debate but hardly authoritarian as there are few sanctions in place for what to me seems a quite mile demand – that people be called what they want to be called.

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          • People have a right to be referred to by whatever pronoun they choose (within the limits of one’s memory); however the way she phrased it implied that people were being required to use gender-neutral pronouns as a matter of course. There’s a big difference & I’m still not sure what she meant, I was hoping for some clarification.

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          • Jordan Peterson claimed people would be oppressed by Bill C-16. There is nothing in that bill that suggested oppression and there has been no case of anyone oppressed because of it. Using that bill as evidence of social control and censorship is a non-starter.

            Peterson either didn’t understand it or was spreading misinformation, and apparently you don’t understand it either. The moral panic he rode to fame wasn’t based on any genuine concerns. Yet Peterson has never admitted that he was wrong or apologized.

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  2. So the problem with psychiatry is that it is used for different purposes and outcomes depending on the winds of politics in a Country. What are the failings of Marxist psychiatry, they are being used in a Capitalist society! Never seen a politician treating patients in a psych. ward. It seems to have been the choice of psychiatry in order to please the society. Sounds like psychiatry is it’s own worst enemy! This is why I walked away from the Idea that psychiatry could help me in any way! If your living in a Capitalist society, psychiatry using Marxist anything is nothing more than an attempt to change the society through psychiatry! Yes we are seeing this play out as the wonderful ideas of Marxist thinking from Nora Volkow and others have become Guidelines Where addiction is an incurable brain disease that you will have to permanently change your behavior and cannot ever control yourself on your own, you need Gov. to do it because humans cannot be trusted to make their own decisions! This came about during a “Marxist” Presidency and is being followed by useful idiots! Can’t get a pain pill for your kid when they get their tooth pulled! Political psychiatry is the choice of the psychiatrist not the patient. When you are looking for help from psychiatry to have success in life which includes the society you live in and it is Capitalist, Marxist philosophy, ain’t worth crap to them. It’s a way for Marxists to change the society they live in by filling the heads of it’s patients with the crap that if only society was different! I am old enough to remember the 70’s and what psychiatry was like. It is back and it is political and worse than before! But, controlling psychiatry has been one of the goals of Marxism, since Marx wrote his book! I’m not fooled! I think the conclusions that Capitalism is using Marxism, is false. It’s the other way around. It’s a Capitalist Society and Marxists are using psychiatry it to change Capitalism and blaming Capitalism for what Marxist psychology says is wrong with Capitalism! That’s why psychiatry in the 70’s didn’t help me at all! I saw through it, just didn’t know what it was! The best example how Marxist psychiatry won’t work in a Capitalists society! Look at the Veteran Suicide rate! Maybe it (is) working at the VA hospitals! Time will show if psychiatry wants to stay a tool of politics or just want to help people deal with the society they are in or will it continue to be used to change that society! Sounds like this Cohen is playing a con to me!

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  3. It’s very good indeed to see a contemporary Marxist critique of psychiatry as a tool of neo-liberalism. There have been Marxist analyses along these lines in the past, but to have something available in the present is more of the kind of thing that is needed.

    Although many of the limitations of Marxist theory are evident in the review of this book, I’m grateful that it has been published. If we were to change Marxist analysis to anti-capitalist analysis I might be more in agreement with that analysis and more ‘on board’. All you have to do, to get the gist of the problem, would be to change the words neo-liberalism and capitalism for socialism. I see authoritarianism as the real problem here; an authoritarianism demanding social control; an authoritarianism that affects not only neo-liberalism policy, but that also is endemic to much modern Marxian policy.

    Marxism, after a fashion, too, has only replaced official religion with its own religion, inverted Hegelianism, Scientific Materialism. A Scientific Materialism that flies in the face of the social choice, Susan Rosanthal, the author of this review, suggests we would be making. In Marxism, those choices are made for us more than by us, the masses of humanity being subjected to the force of economic pressure beyond their control. ‘Free will’ is not a concept particularly amenable to deterministic (a trait shared with psychiatry) Marxism.

    I’m glad he is going after the psy-profession. Psychiatry could not lock up “rule-breakers” if there weren’t a law handing “rule-breakers” over to the medical profession. Were it to do so, without this law, psychiatry itself would be in violation of the law, and as such subject to criminal prosecution. The entire psy-profession is guilty of collaborating with psychiatry in this matter, and reversing the harm, more or less, means opposing the psy-profession, too.

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  4. Susan

    Thank you for this very important and powerful blog about this new book focused on a Marxist analysis of “mental illness.”

    This is an important book to discuss, and the critical issues you raise in your book review were very insightful regarding both the strengths AND weaknesses of this particular Marxist analysis.

    First off, it is absolutely necessary to start from a class analysis when viewing the history and nature of modern Psychiatry and it related oppressive “mental health” system. This book appears to accurately portray how Capitalism has had an increasing need for an institution like Psychiatry, and all their “genetic theories of original sin” – to shift focus away from a “diseased” society to “diseased” individual members within the society. This has become a useful and necessary means to maintain control in an increasingly more volatile world.

    I have pointed out many times at MIA that Psychiatry (and the entire “mental health system) has increasingly targeted (with labels and mind numbing drugs) those sectors of society who have consistently been historically the most active creative agents of change – this includes, minorities, women, prisoners, and other non-conforming sectors within our society. This has especially been the case in a post 1960’s world political landscape.

    The political and economic collusion between Psychiatry (APA) and Big Pharma since the 70’s contains many important lessons about how Capitalism currently attempts to maintain control of the masses, and how CRITICALLY IMPORTANT it is for all those who dream of a Revolutionary transformation of society to understand and oppose these developments. Unfortunately today, many on the Left do not understand these developments and the importance of working in this political arena.

    Susan, I am so glad to you pointed out how the author tended to dismiss or deny the critical role of the working class/proletariat AND its allies in bringing about the end of Capitalism and all forms of class oppression. And yes, there has been a dangerous and incorrect *religiosity* type legacy within Marxist theory to somehow view Revolution as “inevitable” WITHOUT the true makers of history *the masses* being the creative agents of change through CONSCIOUS and STRATEGIC activity in the material world.

    For all those people who believe that Socialist and Communist theory has remained stagnant and become obsolete over the past 4 decades, this is NOT TRUE. There have been some Communist theorists such as Bob Avakian, who have attempted to synthesized a new theoretical and strategic approach to Socialist/Communist Revolution. Check out the following link:


    This is a powerful statement that is SO TRUE. And I would add that all forms of abuse that exist within today’s “mental health” system will not end until we move beyond a profit based system. This System (both Capitalism and its related “mental health” system) cannot be remodeled OR reformed; it must be completely dismantled.

    With the election of a Fascist Trump regime in the U.S., we all have important moral and political responsibilities to oppose these development, and also some favorable conditions to raise people’s consciousness about ALL forms of oppression and ways to seek an end to this Madness.


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    • Richard,
      Wasn’t it both communist Russia and the socialist Nazi party in Germany, not the true competitive market based capitalistic system that used to exist in America, that both previously abused psychiatric powers? I agree the current US crony capitalism system that exists today is just as evil as either communism or socialism, however. But a competitive market based capitalist system is not the system that created psychiatry, Susan is incorrect about that.

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        • Nazi Germany had a capitalist class and a working class. There was private ownership of businesses and competitive markets. People worked jobs that paid them wages or salaries. Then, with their money, they bought products on the market and paid for rent and bills.

          Nazism wasn’t socialist in the slightest. Yes, it was corporatocratic authoritarianism (alliance of big gov and big biz), in that there was not democratically free markets. But, as far as that goes, there aren’t democratically free markets in the US either, as the US is a banana republic.

          As for Stalinism, that wasn’t communism either. All that Stalin did was to rebuild the Russian Empire, make himself the new czar, and then industrialized the peasant workforce. One of the first things the Stalinists did was to persecute, imprison, and kill the left-wing labor organizers, trade unionists, Marxists, Trotskyists, and anarcho-syndicalists.

          There has never been a socialist or communist state, much less a Marxist state. If we are to criticize the left, we should do so on the basis of a failure to have yet created an example of such a large-scale left-wing government; but many left-wingers argue that would require an alternative to statism altogether, certainly an alternative to imperialism, Stalinist or otherwise.

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  5. Why do I feel like this is going to be a frustrating read? I haven’t even begun, I will concede, however ANY analysis of “mental illness” is destined to irrelevancy as there is no such thing, and the fact that the term is not in quotes does not bode well for whatever is to follow. But I guess I’m about to find out.

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    • “A professor of sociology at the University of Auckland, New Zealand, Cohen informs us that

      the current discussion is a critique of professional power not of personal experience and behaviour which may have been labelled (or self-labelled) as a ‘mental illness.’ (p.3)”

      He seems to be saying that social problems get mislabeled “disease”, not that they are such, and he claims that psychiatry needs to be abolished.

      I can’t disagree with him there.

      You should see the price of the book though. I find the price intimidating. What sort of proletariat can afford a 95 dollar/euro book? & as a 75 euro e-book? This is, of course, coming from academia rather than the streets, but nonetheless.

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  6. Hi Susan, cheers on your research! It sounds pretty needed at this point in time… sorry you have to deal with heaps of misguided commentary from people who refuse to learn what words mean.

    You say: “Many books expose psychiatry’s crimes against humanity. However, few analyze psychiatry in relation to capitalism, and even fewer attempt this with a marxist analysis.”
    Here are a few that might fit the bill:

    Capitalism and Schizophrenia
    Gilles Deleuze/Félix Guattari – University of Minnesota Press – 1983

    The Wretched Of The Earth
    Frantz Fanon – Presence africaine – 1963

    Complaints and disorders: the sexual politics of sickness
    Barbara Ehrenreich-Deirdre English – Feminist Press – 2011

    The protest psychosis: how schizophrenia became a black disease
    Jonathan Metzl – Beacon – 2011

    And the documentary “Century Of The Self” (Kurtis) is excellent too, for a look at how industrial psychology is used to regiment the lives of “normal” people (via the Gruen Transfer, etc.) just as much as it’s used to categorize and police the “Mad”.

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  7. Despite my immediate apprehension at seeing the term “mental illness” being used in the title without quotation marks (which I still consider to be a flaw), I am thrilled that this book has been published, and the review itself adds further fuel to the discussion. I suspect this will be a long comment section. My contributions will come in short bursts since there is too much dialectic going on here to summarize my thoughts in a few comments.

    Cohen’s book promotes an analysis of psychiatry as a system of social control and repression, rather than as a misguided field of medicine, something I have been trying to emphasize as well. To treat it as an aberrant field of medicine which needs to be “improved” is to set ourselves up for failure.

    Psychiatry supports capitalism by ‘diagnosing’ socially-created problems as individual cognitive or biological defects, providing pseudoscientific ‘evidence’ for blaming the victims of the system.

    In other words, it’s more conducive to maintaining social control to have a million unhappy people seeing their misery as “personal” problems to “work on” as individuals (and to be ashamed of), rather than recognizing their common oppression and joining forces to fight the system.

    The pharmaceutical industry plays an important but secondary role.

    Interesting assertion, probably correct, but more significantly something I’ve never seen discussed before. I would agree that while the billions of dollars raked in by pharma are a big motivation to keep psychiatric repression going full tilt, even without this particular profit motive capitalism would still require psychiatry to maintain control of the populace, for the same reason as above. The 1% cannot maintain control simply through cops and armies, they rely on “self-imposed” internal restraints on people’s aspirations which are the business of psychiatry to inculcate and reinforce.

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  8. Oldhead

    Good points.

    While the high profit margins of the pharmaceutical industry is of a secondary nature when analyzing the necessity of the institution of Psychiatry for the survival (through social control) and growth of Capitalism, we should not minimize its significance either.

    The high profit margins of Big Pharma over the past 3 decades, especially the marketing and sales of psych drug in particular, have made this industry vitally important to the future preservation and growth of capitalism. Big Pharma may have become TOO BIG TO FAIL in the increasingly competitive world markets among other Imperialist powers.

    Also, we should not minimize the role of Big Pharma (and their drive to maximize profits) in the almost total control and manipulation of ALL SCIENTIFIC (pseudo-scientific would be more accurate) research promoting and justifying the use of harmful psychiatric drugs. I would argue that there cannot (and will not ) be the development of safe and more effective science in medicine (and no, Psychiatry is NOT medicine) until we move beyond a profit based economic and political system.


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    • Pretty much agree all around. Pharma may be second but it’s a very close second. Doesn’t really matter what the “most” important organ is, as without the second most important you’d still be dead. Psychiatry and pharma have developed a symbiotic relationship that I doubt could be undone even if they wanted to do so. “Psychotherapy” alone cannot keep the masses at bay. 🙂

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  9. I look forward to MIA publishing some classic excerpts of Solzhenitsyn’s experiences of psychiatry under Soviet communism, and some accounts of communist China’s very current misuse of psychiatry, or of Cuba’s.

    Does MIA speak for everyone harmed by psychiatry, or just those of certain ideological stripes? There’s no indication from the history of the globe that any ideology can deal with ‘mental health’ responsibly or compassionately.

    Liz Sydney

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    • Save yourself some trouble, as nothing in Solzhenitsyn’s experience in the gulags has relevance to what is being discussed here. There was never such a thing as “soviet communism” and what is represented as such was at best a stunted version of socialism. Historically speaking though, socialist revolutionary struggles have not “failed” so much as they have been defeated — there is a difference. Check out and consider my response to your first comment.

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      • PS — Marxism is not an ideology, it is a scientific method of approaching an understanding of power and economics, and for developing strategies and programs via which to throw off the unnecessary parasitic classes which produce nothing, yet feed off the people’s labor and energy. Marxists argue with one another just like physicists and, while there are shared principles, how these are to be applied is a constant debate, and just because a “Marxist” does something in the same of Marxism it doesn’t necessarily represent a consensus.

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    • As oldhead pointed out to you above, the Soviet Union was never a true communist state. We’ve all grown up with and have become enculturated by the “communist” bogeyman via our capitalistic media.

      (pressed ‘post’ the same time old head did, but it doesn’t hurt to reinforce the point)

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      • Doesn’t hurt at all — I think you would probably also agree with my previous point that “communist state” is an oxymoron, as when communism is ultimately achieved all states would have disappeared. Pointing to the U.S.S.R. to denigrate communism is as specious as trashing democracy by pointing to the example of the U.S.A.

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          • Communism can refer to two things: a) The final stage of the transition of humanity from capitalism to a stateless society (with socialism as the intermediary phase); and/or 2) The political movement dedicated to achieving such a transition.

            Humanbeing is correct, there has never been a truly communist society or anything close. But there were never airplanes before people visualized them, made many retrospectively silly mistakes, and crashed and burned more than a few times. My point was mainly semantic — i.e., as communism means a stateless society, there cannot be a “communist state.” Generally what people mean by “communist” countries are countries which have attempted to institute socialism. Such efforts succeeded for awhile in the USSR and China; however these gains were swept away eventually and new forms of capitalism were established, which is the situation in both countries today (although I just read that China is experiencing a resurgence of revolutionary energy being labeled “neo-Maoism”).

            Anyway, I would compare what you correctly call idealism with that first vision of a flying machine decades or centuries before it materialized.

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          • @oldhead – Your example of early airplane prototypes is useful. Most probably never got off the ground and the few that did quickly crashed. Is an airplane any device designed with the intention of flying or only those devices that actually flew? That seems an important distinction. Besides, we have to shift our understanding even further back.

            Humans probably imagined and argued about the possibility of human flight at least centuries, if not millennia, prior to actual flight being achieved. Even when the Wright brothers invented an actual functioning airplane that was observed in flight, many at the time still denied it was possible. Change happens slowly, until all of a sudden it happens quickly.

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    • I think all of those are well worth investigating.

      Are you saying that the state uses psychiatry to keep dissent under control?

      If so I can only agree though I also think those harmed by abuses of power, those who are distressed, are detained, druged and the causes of thier distress ignored. It has always been like that as long as psychiatry has existed.

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  10. Moving along…

    Cohen explains how psychiatry frames ‘under-performance’ at work as an individual ‘mental illness’ requiring ‘treatment.’

    Exactly!!! This underscores the value of our existence being measured in terms of how much profit can be squeezed out of us. We are allowed to expect just enough food, sleep, free time and emergency medical “care” to get our bodies through hours and years of meaningless work. If we aren’t down with the drill we are “underperforming” — but whose circus is this anyway?

    “It is no longer enough just to shift product, one must now do it with a smile, with ‘sincerity,’ with a friendly touch”

    Nope, we can’t simply succumb complacently to eating shit. We’re expected to like it, otherwise we’re “disgruntled.”

    Unfortunately this attitude is often promulgated on MIA in blogs and comments which equate successful “therapy” with holding a job, any job. Even if it’s personally or environmentally destructive.

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  11. The far reaching powers released some psychiatric medicines such as antipsychotics because they are illnesses of unreasonable pain

    It helps those who need it and hurts those that take who don’t need. Taking something you don’t need goes against basic tenants that foster strength and power so this deserves harmful consequences.

    It’s bait and many people bite and then become ensnared.

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  12. In the 1900’s the hegemony or hierarchy wasn’t set up as bait and you can kind of see this in the book review. In modern times it is more like bait. Individuals bite from so many areas (not just pharmaceuticals) and then become ensnared. The amount of individuals overweight or obese is another example from what I mentioned in above about taking what you don’t need.

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  13. I find this quote interesting: “Capitalism needs psychiatry to impose social control because it fears working-class revolt. The greater the threat, the greater the need for repression.”

    Bio-psychiatry and mass drugging took off after Reagan and Thatcher were elected. Market regulation was reduced, state assets sold off, unions systematically reduced in power.

    There was a battle between capital and labour in the 1970’s and labour lost. So bio-psychiatry rose as the corporations had more power but under this analysis maybe more psychiatry is needed by capital to keep the working class from rebelling against the sale of state, ie shared, assests, cutting of benefits and growing inequality?

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      • I think it is more complicated. I think labour, and specifically trade unions, have not adapted to the new conditions.

        For example I know a teacher who was bullied at work. Bullying of teachers is now endemic in the UK due to the constant monitoring of pupils and teachers and the league tables and comptetion between schools which has turned many heads into petty tyrants. Meanwhile unions reps are distant. They will help you in your harrasement case against the boss but they don’t bring teachers together to talk over what it is like being a teacher now and encourage them to support each other in resisting the petty beurocracy. My freind went off work with stress and gets prescribed drugs, luckily not anti-depressants as they make her ill, but beta blockers to deal with her racing heart.

        I think labour lost in the 70’s. Work becomes more stressful, as did the rest of life. Unions and other labour organisations have not regrouped and come up with new strategies and inequality got ever worse.

        Paolo Friere outlined a way of working that involved getting marginlised groups together to ask the three basic questions:
        1 what is life like round here?
        2 how do you feel about that?
        3 what shall we do about it?

        Although more broad strategies are also needed I think that to regroup trade unions and other left groups need to do a lot of the kind of work that Friere outlined. Without that basic work when people feel distressed they fall into the hands of psychiatry and psyche drug prescribing GP’s.

        I can see how anti-stigma campaigns do fall into the analysis that you wrote in your blog. The anti-stigama campaigns say it is OK to be distressed, just go to the GP. The GP prescribes drugs and maybe six weeks CBT when what you realy need is solidarity at work and a better place to live with lower rents. Sp the anti-stigma campaigns may help stop the distress turning into organised rebellion.

        I find it interesting that shortly before this blog was published another was published about Open Dialogue and social justice where Friere’s name was used. But then mental distress is so often the outcome of the abuse of power

        Sorry my reply is terse. I feel you deserve a fuller response than the one I have given but I hope my meanings are clear.

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        • “Stigma” needs to be recognized as the bigotry of others towards the psychiatrized, and nothing more complicated. “Anti-stigma” is pro-psychiatry/pro-drug at its core, as it is meant to remove roadblocks to public approval of mass drugging and the medicalization of dissatisfaction. Stigma is inherent to a psychiatric “diagnosis.”

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        • Labor lost during the 1970s? Perhaps we all lost. The rich are getting richer, everybody else is getting poorer, and the US just elected a 1 %-er head of state. I wouldn’t imagine there could be a situation more due for dramatic change than the one we’ve got. If the honeymoon is over, it’s not the end of the world. Here comes the divorce, the marriage, and the honeymoon.

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    • It’s similar to Noam Chomsky’s argument that propaganda is needed more in a supposed democracy than under authoritarianism. The reason is that authoritarianism has many other more direct and effective means of social control.

      Propaganda is about getting people to internalize ideology so that they will police, censor, and manage their own identities, thoughts, and behaviors. That is more important in a democracy or a pseudo-democracy where the illusion of freedom has to be maintained.

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  14. Interesting discussion. As a person who was locked up as a young person and rejected/escaped the medical model but found help in therapy and mindfulness teachings, a parent of a young person who in the summer of 2014 went through a two week extreme experience (with an Open Dialogue informed approach) without heavy drugs (just some very minimal drugs for sleep for a very short time) and is now living a full life without these difficulties and as a mental health counselor and “professional” who has struggled for 34 years to find my way to meaningful “help” for those in need, what should I (we) do? I agree that our society is the reason so many of us struggle, but people do struggle with real pain, extreme experiences and life threatening situations. How can we support or respond to them in our current neoliberal, capitalistic world? Where do we start? I ask these questions with humility. I am still trying to find my way to change things for the better. So far, the dialogic, relational and peer approach are the most democratic and non-violating ways I have found to respond. Thank you for all of your shared thoughts.

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    • I think re-localizing efforts and the transition community could be a way to help us reconnect. We’ve become atomized and alienated from ourselves, our neighbors, our families and the natural world.

      We need imnsho, to dial it down, and live closer to what is authentic.

      Or it may be that things have spun so far out of control with population/’resource’ pressures, that we might just have to make peace with this life and prioritize what’s important to us, then love it as if there’s no tomorrow.

      Oh, hell…we’re doomed.

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      • Human being, I agree with your solution, but this is not profitable for the crony capitalism system, which is why the psychiatrists have been, for decades, attacking those of us who behave in manners that are actually beneficial to society, but not profitable for the psychiatrists’ European banking masters and their crony capitalist system.

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    • “dialogic, relational and peer approach are the most democratic and non-violating ways I have found to respond.”

      Who is to pay for these?

      Either people campaign for the state to pay or money is found for independant groups to provide.

      Current power structures want drugging and incarceration as it makes money for the rich.

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    • We need to recognize that all we can do pending the necessary political/economic transformation, which is the sine qua non, is collectively tend to our psychic wounds as best possible while struggling to eliminate the political conditions and social structures which inflict them. Such support needs to be ingrained in the ways we relate to each other, not regarded as a professional specialty.

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  15. Two comments:

    1. You ask, ‘Who will remove psychiatry’s compulsory powers?’ In fact, this is easily done from a technical standpoint by repealing legal provisions that authorize those powers.

    Law like psychiatry is a creation of human beings, psychiatry does not have any inherent powers to violently act on anyone’s bodies. It is given those powers by law, and law in turn must be accountable to both political processes and to fundamental principles of human rights set out in constitutions and in international human rights law to the extent that any country’s political and legal system provides for this.

    In 2006, the Convention on the Rights of Persons with Disabilities (CRPD) set out a number of rights and principles that require the abolition of psychiatric commitment, forced treatment and substitute decision-making. I was actively involved in that process and represented the World Network of Users and Survivors of Psychiatry in proposing and explaining these provisions that were successfully enacted into the treaty. At last count, 172 countries are states parties to the CRPD, and it is legally binding on them as a matter of international law. (Many of them do not treat it as binding in their domestic courts, but some do; some even consider such human rights treaties to govern on a par with their domestic constitutions.)

    The committee of independent experts that is elected to monitor compliance with the CRPD, the Committee on the Rights of Persons with Disabilities, has interpreted and applied its provisions to require an end to substitute decision-making and the absolute prohibition of forced treatment and of deprivation of liberty based on actual or perceived disability. They have said that states must repeal legal provisions such as those in mental health laws allowing deprivation of liberty based on factors such as danger to self or others, or need for care or treatment. For more information and resources, you can start at, an organizational website of the Center for the Human Rights of Users and Survivors of Psychiatry.

    2. (This comment is both to the author of this blog and to the book she is writing about.)
    If we look only at psychiatry as a modern phenomenon, we lose the history of how societies have dealt with what they perceive as madness, and how modern day societies that do not have a large psychiatric or mental health professional presence deal with madness. There is some good and some bad; in some societies people may be tied or chained to trees or locked in sheds because the mother of the household needs to go about her duties and can’t care for them. This is seen as the woman’s duty and the family or community participate in this dehumanization as, in in some other countries families and communities participate in the dehumanization of people through psychiatry. They do not see alternatives, and participating in dehumanization perpetuates their perceptions of the person as warranting such treatment, and affects the person in many possible ways, but all of which do not allow them to break out of how they are seen by others. (Again, this is true in both psychiatric and non-psychiatric settings.)

    In some societies there are traditions of madness being seen as shamanic initiation or leading to shamanic initiation. This is fine, such practices should be supported and have also inspired many in other cultures to have a different view of the spiritual crisis and/or emergence that madness can be.

    That leads me to two points about what is missing from a Marxist analysis as described here. First, patriarchy as a system of oppression prior to, intersecting with, absorbed into, parallel to, and/or competing with capitalism appears to be overlooked. Feminist Marxists have called attention to this blind spot in mainstream (male-dominated) Marxism for at least decades. I find the book ‘The Sexual Contract’ by Carole Pateman to be useful in understanding how patriarchy was transformed by capitalism. Patriarchy also is implicated in psychiatry and it is not enough to acknowledge that psychiatry reinforces women’s oppression. Patriarchy has been analyzed as a system, similar to capitalism, that in some part can account for psychiatry (e.g. in Mary Daly’s Gyn/Ecology). I do not think that either system fully accounts for psychiatry, but certainly we need to look at all of them. (In addition, institutionalized racism, or what I have heard described as racism as a practice, similarly can provide a partial account of the development and existence of psychiatry as a system of social control.)

    Second, there is something that I think is separate from any other framework of system of oppression, that leads human beings to treat some members of a society as too different to be accepted in the community. It is a widespread phenomenon that I think is accurately described as disability-based discrimination, or simply exclusion of members of the community (also including older people) that appear to be weaker or who are made weaker by others’ reactions to them. We can talk about specifically how capitalism treats disabled people as ‘useless eaters’ and patriarchy puts disabled people under the control of male heads of the family or their surrogates, while making women responsible for either care or abuse/neglect, and for carrying out both the abuse/neglect and as directed by the patriarchs and other the measures they dictate for management and control. It would be interesting to look more deeply at Feminist-Marxist analysis of how women, and other subordinates like non-psychiatric mental health professionals, are roped in and have an intermediary role in the oppressive system. And, to look at how psychiatry came to serve patriarchy in an era of capitalism, by transferring social control and the abusive/neglectful care involved, at least in part from women in the family to a monetized system and its employees. And yet, without an ‘intersectional’ attention to disability-based oppression/disablement in particular, I cannot expect that either feminism or marxism will pay attention, and so I wonder what the material basis is of disability-based oppression as such, and what more we need to address in theory and practice, beyond simply rising up for liberation.

    So to conclude (linking up with my #1 above), there’s a linkage with law and custom both in state and non-state societies, in thinking about how societies respond to distress and difference. Law both reflects and replicates a social and economic and political order (and a sexual order, and perhaps an ability order of some kind). I think that law is an important site for change while at the same time recognizing and being vigilant about the underlying systems that will act to recreate themselves if we do not make deeper change (Michelle Alexander has made this point more emphatically and concretely than any other writer I’m aware of, in The New Jim Crow). Thanks for this blog and for the discussion.

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    • An article in itself, thanks for this. I was hoping this discussion section had only just begun.

      You ask, ‘Who will remove psychiatry’s compulsory powers?’ In fact, this is easily done from a technical standpoint by repealing legal provisions that authorize those powers.

      That was my thought as I read that — it’s not a mystery, technically, as to how to end compulsory “treatment.” Of course it is a huge dilemma as to how to garner the critical mass to demand such legal changes. A crucial hurdle is educating the “mainstream” to understand that “mental illness” is NOT “a disease like any other.”

      If there is one thing MIA doesn’t lack it’s enough women to speak for themselves regarding specifically women’s issues. So I won’t really dive into most of the questionss you bring up here. I will say that one of the most serious challenges that Marxist organizations and movements have faced has been to try to incorporate an understanding of systemic patriarchy into their analyses of capitalism and class struggle. Some have been better at this than others. It’s obvious to me that patriarchy and capitalism in the present day reinforce one another. The same can be said for capitalism and racism. Before these contradictions are resolved there will be no significant progress for humanity as a whole.

      Btw are you familiar with Selma James and Global Women’s Strike?
      (Not to be confused with the recent “Women’s Global Strike,” GWS is a radical working class women’s organization.)

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    • Tina

      I have great appreciation and admiration for the work you do in the international/legal arena as well as, your struggle against all remaining vestiges of Patriarchy in our society. This includes within those movements claiming to be advocating for Revolutionary transformations in our society.

      When looking at the history of the Supreme Court in this country, their interpretation of the Constitution and Law (in general) has NEVER had some kind of inherent permanent essence divorced from the actual nature of the class struggle going on in this country at any particular time. They would have us believe that Supreme Court decisions are somehow PURE and unrelated to the political climate of the times.

      When looking at the history of racial politics in the U.S., the Supreme Court held onto the LEGAL interpretation/belief that Blacks were three fifths of a human being until this so-called accepted LEGAL belief had become totally UNTENABLE with the class struggle going on in the country as a whole.

      In this case it was Northern industrial capitalists in major conflict with Southern plantation owners holding onto a now archaic labor intensive slave system of production. This combined with a growing Abolitionist Movement (leading to international embarrassment and pressure) that all culminated in a major Civil War that led to a very bloody resolution of these contradictions.

      In the case of Psychiatry, with their power and legal rights to circumvent basic Constitutional freedoms (with forced drugging and incarceration in psych wards) that actually matches the same power as the Executive branch of the Presidency, how will this all actually be changed WITHOUT a corresponding level of mass class struggle that matches what took place place (for example) in the Civil War era?

      In others words, don’t we need a very powerful political movement in this country (including possibly another Civil War) in order to create favorable material conditions for such a dramatic shift in the Legal realm of government as it pertains to the power of modern Psychiatry?


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  16. Privatized reproduction lies at the root of many problems, including women’s oppression and the oppression of those who are seen as less productive.

    When the weight of caring falls on individuals, they cannot do it all, so caring becomes ‘control.’ In contrast, when caring is a shared social responsibility, there are more than enough resources to meet everyone’s needs.

    Diversity is a threat to class societies and an asset to egalitarian societies.

    In societies where human needs comes first (meaning everyone’s needs), there is more acceptance of, and support for, those who are different – for whatever reason.

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    • You can end up drugged and in restraints after entering a general hospital with a physical complaint. It is not just psychiatrists who have access to means of oppression. And medical ward can pull it off.

      A long and rambling anecdote I can’t get off my mind, which I’ve written here before:

      An elderly woman who is very close to me was degraded in the worst ways after entering an emergency room with the purpose of having a laceration on her scalp sutured.

      Actually, that’s wrong. She didn’t intend to go. Her husband tried to keep the paramedics from taking her. The cut was about 3/5 of an inch in length and had finished bleeding. She’d hit her hed on a door as she fell to a carpeted floor. She fell because she was on a beta blocker that caused her to fall. She didn’t know it was the drug. I don’t know if her doctor knew she fell a lot. If he didn’t, it’s his fault for not asking. There was no reason to go to a hospital, but the paramedics who did the transporting work for a private company with a contract to be the city’s paramedics. They pay the city a fee for the privilege of providing the service and billing what they can for it. The bill for the 2-mile transport was $2000.

      Once there, the old woman was subject to every sort of test and scan imaginable, despite having no complaints. No pain. She was 82, and wasn’t able to state her birthday or what city she was in. It was assumed she’d had a terrible head injury. She hadn’t. She just didn’t know her birthday or where the ambulance had taken her.

      I believe she was addled by a very high dose, for her age and small size, of a beta-blocker called Atenolol. Hospital staff called her pharmacy to find out what drugs she took and bungled it. A fateful mistake. They came away with the belief that her was 50 mg/day of the ineffective crap, Atenolol, she took for a non-disease, hypertension. In fact her dose was a whopping 150 mg/day. Because they didn’t know she was on a high dose, they didn’t know that her sense of panic and need to get out of bed the next morning were Atenolol withdrawal. They didn’t know anything. MORNING NOTES: “Patient kept trying to get out of bed and was combative.” They forced Haldol into her and put this kind, shy, and mentally brilliant women in 6 point restraints. They kept her in them for 26 hours. Unfortunately her husband didn’t visit during that horrible period, but when he did arrive, he saw what had been done and undid it, as the banal and sadistic soulsucking nurses watched from a safe distance.

      A laceration that was not bleeding, little more than 1/2 inch in length. The wrong questions asked for the alert-and-oriented test. (Should just be: who are you, where are we, and what time is it.) Not a reason to commit someone or to fight them physically when they wish to leave. Correctly: “Patient wished to get out of bed. Staff were combative.”

      I’m glad she fought them, and very sorry she was out-numbered.

      There were no psychiatrists, not even a doctor who had finished training. She went in psychiatrically “well,” was made unwell by the beta-blocker dosing mistake, and then made worse by inhuman, degrading, humiliating and infuriating treatment selected by a resident. Instead of being tied up, she should have been discharged. As an elderly person who might have had dementia for all they knew, injecting Haldol was criminal. There was nothing wrong with her when she went in. Her soul was a carcass when she got out.

      It was this resident who wrote the orders for the abuse.
      He has the kind of face I can’t stand at the best of times.

      The patient’s life ended without her dying. I knew when I heard what had been done that she, given her nature, would not be intact. She was a severe mess for a while. She had delusions about the composition of the household and believed there were two copies of her husband. She wanted to kill herself and broke down crying on occasion, something never seen before. It’s always sickening when humans beings are abused and especially so when a person has led a laudable life and has reached age 82 and wishes to coast the last ten yards, and is instead mangled and spit out and left, in scraps, to cope. She has coped.

      She didn’t both with Atenolol after that. From 50mg to 0mg just happened. She hasn’t fallen down since.

      When I heard she’d been injected with Haldol, I called and told a nurse not to do it again. I said I am a psychologist, having earned a doctorate in social psychology, specializing (involuntarily) in gerontology. In the notes it says: “Jane Doe called, claimed to be a psychologist.”

      At one point the patient apparently exclaimed “You’re not doctors,” to the assembled torment squad of non -doctors. This too was noted, as if it were a ridiculous thing to say, like this, “You’re not doctors!”

      Number of deaths from falls has risen since 2004, when 41 per 100,000 elderly persons per year died after falling. By 2013 it was 57, a 39% increase. Surely that’s more lethal than the opioid epidemic.

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  17. BetterLife

    Thank you for that story of medical/psychiatric oppression that is SO common these days.

    The dangers of anti-hypertensive drugs are under appreciated.

    AND MOST IMPORTANTLY, the rise in fractures and falls in the elderly parallels the rise in BENZODIAZEPINE PRESCRIPTIONS that have dramatically risen (especially targeting women) over the past 2 decades.

    In fact, THERE IS NO OPIATE DRUG OVERDOSE CRISIS in this country, in reality
    there is A POLY-DRUG OVERDOSE CRISIS, where BENZODIAZEPINES more often play THE DECISIVE ROLE in the deadly drug cocktails that kill so many people.

    And Psychiatry, Big Pharma, and the FDA are guilty of the worst kind of medical negligence and manslaughter numbering in the hundreds of thousands. All of which is fueled by an underlying drive for profits and power that is inherent within a Capitalist system.

    None of this will end through a struggle for reforms. True reform (or more accurately labeled as TRANSFORMATION) can only come about through a struggle for Revolution – that ultimately means moving beyond a profit based Capitalist system.


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  18. Psychiatry, Psychotherapy, Life Coaching, Evangelical Christianity, and the Recovery Movement definitely do serve the needs of Capitalism.

    But Marxism, at least as known so far, does not provide an alternative. By the early 1930’s Wilhelm Reich and those of the Frankfurt School made it clear that The Family, was the problem, and that it must be abolished.

    And this is what Alexandra Kollontai, Lenin’s first Minister of Women’s Affairs, had wanted too.

    But by the early 30’s, Moscow issued a directive forbidding any criticism of The Family. So for this reason, our Marxist states are not that much different from Capitalist states.



    We Need An Anti-Mental Health Anti-Recovery Forum:

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    • Psychiatry, Psychotherapy, Life Coaching, Evangelical Christianity, and the Recovery Movement definitely do serve the needs of Capitalism.

      But Marxism, at least as known so far, does not provide an alternative.

      Isn’t proving an alternative to capitalism kinda exactly what Marxism does?

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  19. Next noteworthy quote:

    Of particular note is the increased use of the terms ‘delusions of persecution’ or ‘paranoia,’ from 3 in DSM-4TR to 14 in DSM-5

    This is something which also seems as though it should get more attention. Who decides what is a delusion and what is an insight into the way the machine works? Who decides which fears are rational and which are irrational? These are political judgements, fully subjective. There were some old hippie buttons that said things like “Paranoia is heightened awareness” and “Just because you’re paranoid doesn’t mean they’re not after you.” Obviously this is more than humor.

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  20. So as far as solutions are concerned, I think the way this particular conundrum plays out is that the victory of people over private profit IS inevitable, but the time line is completely unpredictable, and how long we must engage in trial and error is an open question. The longer we wait around for that “inevitability” to manifest the longer it will be, as power cedes nothing without a demand. If it takes too long the earth might already be environmentally doomed by the time we “win.”

    But here is where I might diverge from the author’s perspective:

    While understandable, it is a mistake to counterpose psychiatric survivors and workers in the ‘mental health industry.’

    Yes and no. A “mental health” worker who is actively working to abolish psychiatry as a practice might be considered an ally of the anti-psychiatry “survivor” movement. Keeping one’s job would be most challenging for such a person if they were sincere. But an active anti-psychiatry movement should be primarily led by conscious “survivors” who have experienced psychiatrization, especially involuntarily. (And if any “movement” on our behalf is NOT straight-up anti-psychiatry it is not legitimate.)

    most do not enter the industry to serve as agents of oppression, and when they realize they are, they can become magnificent fighters against it.

    “Can” is the key word here. It has not been our experience that many do. Usually when the choice between principle vs. getting paid comes up the latter wins out, and the revisions and rationalizations start.

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    • The author you are citing is the author of the blog post and book review, Susan Rosenthall, rather than the author of the book, David Cohen, where she offers a certain objection to his view of mental health work. I tend to agree with you about this aspect of the matter. People who work in this human service industry, the psy-profession, whether at a lowly position or a more prestigious one, do so because it pays, and it pays them to keep quiet on the issue of force and human rights violations. People who speak out on these issues tend to lose what jobs they had within the system.

      We are closer to no mental health system with no forced mental health treatment, and that’s the direction we need to be headed in. Encouraging careerism only exasperates the situation. Careerism that arises from the artificial “disability” industry and the “mental illness” religion it is founded on. Through careerism the system expands. It is a harmful system that a great many of us could well live without entirely. We aren’t getting any closer with a lot of lying hypocrites exploiting the misery they help to create while pretending to be doing something about it.

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  21. Forget about Marx Forget Capitalism, forget about googling what someone else wrote to prove them wrong in order to sound smart in a blog. Which helps no one. That’s not the main objective of this article. After having read this article the most valuable conclusion one can gather after reading this, is how detrimental the psychtriatric system we have in place is and how their authority violates the rights of humanity. Why this system is in place is to serve Marxism and Capitalistic agenda’s, true but not the point of this read. When the governance we submit to has all the right in the world to incarcerate based solely on the fact that the pathonologized victims views do not align with the typical political dogma. This article shines light on the amount of control these entities have over society and how the working class can change this evil elite agenda. As the ruling class and their agenda’s are an act of evil. I have worked in these psychiatric facilities, I have seen normal people, incarcerated and poisoned with mind numbing SSRI’s and thrown into rooms like animals for years on end. That’s not treatment and it is not effective. I have seen abuse and these people are silenced. Yes people are infact ill mentally, but the protocol of treatment is negligence, abusive and counter productive. If you want to be “brilliant” Instead of belittling one another on the internet as I have read in the comments. Why don’t you work together as a functional society to stop these evil forces. ” Instead of having the commentary filled with arguments over the insignificant matters in this article, such as “I am going to disagree with you in efforts to make myself sound of greater intelligence because by pointing out your character flaws I in return make myself seem superior” That’s transparent and it’s mean. That is not how we move forward as a society, that is not how we help one another. You need to read between the lines, find the problem and offer a real and valuable solution based off of your knowledge. That is intelligence. How do you stop an evil ruling system of authority when they can incarcerate those that oppose its agenda(non conformist)?

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  22. 100% true, I skimmed through most of this. It’s a long read and I was tired, although I am deeply disturbed over this system and how its run. Not just psychiatry, all sectors of governance have become corrupted. When people go to school, get a degree, get a job but are left entirely ignorant to see the damage their job does to the people. The whole process of extensive school “programming” is counter intuitive and a waste of time, if your not helping society, your probably destroying it. For social workers, probation, correctional officers, dr’s, the 9-5 work schedule becomes too stressful. Workers become desensitized and non empathetic towards their patients, in order to adapt and relieve the stress of carrying on the emotional weight. This is why kindness requires strength, the type of strength people in this world just don’t have. Indoctrination turns these feelings off as we are taught to fend for ourselves and not love one another. These social workers, etc turn off these feelings of empathy because it becomes the easiest way to cope. That is why abuse and negligence persist and is overlooked and forgotten because that is easiest. So if anything happens in these facility and it violates the patients rights, it is easiest to forget about it and continue on with regimen. As for the intentions of the dr.s themselves. Are they there to help or to profit? I dont know. Profit seems to be an idea assumption after their act of continuous prolonged, potentially dangerous treatment with out any positive result. I could never watch someone suffering knowing that I am the cause and not change anything to make someone feel better. I could never keep, not a being or animal indoors no matter the circumstances. We are human and we need to be free and in a healthy environment. If someone can go to go to school and get a PHD, which requires a great deal of discipline, with in this disciplined process you loose your sense of empathy. Like military personnel, a system set in place made you suffer, now you don’t mind watching others suffer as well. A PHD with out empathy will lead to mad science and mass suffering. Someone may be intellectually suitable for a position as a dr, but not emotionally.

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  23. As someone who has been on both sides of the patient/provider divide I can totally relate to your comments.

    Those of us who enter the medical industry are taught that the priority is patient well-being. We soon discover that the reality is something else – protection of the profession (cover your ass) and subservience to the hierarchy (mind your betters).

    Professional training takes people who truly care about others and teaches them that those ‘others’ are nothing like them. In dividing us from our patients, they divide us from our humanity, and they block our efforts to do anything else.

    Jeff Schmidt’s book, Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-battering System That Shapes Their Lives ( explains that the role of professionals is to help manage capitalism, so professional schools weed out those who won’t go along. Those who slip through the cracks are ‘sidelined’ or ‘frozen out.’ I have been ostracized and threatened with the loss of my licence to practice for treating people humanely. That is the true meaning of insanity.

    Nevertheless, I am hopeful. Medical workers are under attack from the same system that attacks our patients. More of us are suffering burnout from impossible demands, suffocating red tape, micro-managed working conditions, etc.

    Patients and providers have a common enemy and a common interest in defeating that enemy.

    We cannot let them divide us. As you pointed out, we all lose when that happens.

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    • I’m afraid this is a little rich. You can’t criticize the medicalization of suffering and at the same time talk about your “patients.” We are not “patients.”

      Patients and providers have a common enemy and a common interest in defeating that enemy. We cannot let them divide us.

      We may have a common enemy in capitalism, but the notion of “professionalism” is an additional obstacle that those on the receiving end of “professional services” face. The goal should not be “better” professionals but a system in which human support is not a “specialty” and professionalism is obsolete. It’s not simply a matter of “them” dividing “us”; the divisions have been well entrenched for some time. Terminology such as “patient” perpetuates a medicalized mystification of suffering.

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      • Thank you!

        “You can’t criticize the medicalization of suffering and at the same time talk about your “patients.” We are not “patients.””
        == If “not patients,” how would you want to be called?

        “The goal should not be “better” professionals but a system in which human support is not a “specialty” and professionalism is obsolete. ”
        == Can you point to the theory and the practice of such a system?

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  24. Very interesting article that tied together a lot of material I was not aware of before. Thanks.

    I remember the upsurge of the ex-mental patients political activist groups in the early 19070’s, riding on the coattails of the civil rights movement.

    The Radical Therapist put out a similar anti-capitalist agenda as your article. Therapist being broken down into two words: The-rapist.

    You did not mention the introduction of Prozac as coinciding with the middle of Ronald Reagan’s presidency and just after the loss of many jobs from his initiation of neoliberal policies. People were (naturally) depressed when unemployed, and it’s not a coincidence to me of the timing of this drug entering the market.

    Although I appreciate your review of the book on psychiatry and neoliberalism, I contend that you also show no straightforward practical solution to problems it presents –the very same critique you make of the book. Your solutions do not speak to any direct actions, but are academic, as far as I am concerned.

    Political activism and the establishment of alternatives is a very slow and painstaking process that is making progress, but takes so much time and toil that at times seems like it is standing still.

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  25. I find it odd that, according to this piece, Cohen “also disputes the claim that growing inequality and loss of social support are causing more people to become ‘mentally ill.’” I wonder what he might mean by that. There are studies out there that show a strong correlation between increasing inequality and rates of mental illness.

    Inequality is never only about economics. It does include class divides but, more importantly, involves disparities of power and privilege, political representation and platforms of speech. Also, there are inequalities of resources, education, healthcare, nutritious foods, green spaces, clean air and water, stress reduction, and on and on.

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  26. In expanding upon and strengthening a Marxian critique, others mentioned the importance of focusing on patriarchy, racism, etc. I agree with that and would take it further. Mental health is affected by so many factors, many of them systemic and pervasive within capitalist realism.

    Stress is very much real from poverty and inequality; not to mention overwork and unemployment, debt and homelessness. But there are also physical stressors: untreated health issues, heavy metal toxins, air pollution, etc. An example are the toxic dumps disproportionately located in poor and minority communities.

    There is another example that cuts across the entire population. Capitalism goes hand in hand with unhealthy industrialization of the food system, such as farm chemicals and food additives that cause so much harm. Also, there is nutritional deficiencies, oxidative stress, inflammation, and much else caused by a diet of industrially processed foods high in seed oils and carbs.

    It seems like Marxism, if it is really to get down to the nitty gritty, is going to need to tackle these mundane issues of health. Most of the American population is sickly and/or stunted. Consider that 88% of Americans have one or more conditions that fall under metabolic syndrome: obesity, insulin resistance, diabetes, heart disease, etc. Even cancer is arguably a metabolic disease.

    Along with farm subsidies and such, official dietary guidelines have played a major role in shaping the standard American diet that causes so much disease. Have these and other official guidelines really been shaped by scientific knowledge or by big money interests? In discussions about such things as Marxism and psychiatry, too often basic issues of diet and nutrition get overlooked, even though these are also economic and political issues.

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