Capitalism and the Biomedical Model of Mental Health

Psychiatrist Joanna Moncrieff argues that we should abandon the medical model and focus instead on how the mental health system relates to capitalism.

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An article published in the journal Frontiers in Sociology applies a Marxist analysis to the mental health system. The author, the British psychiatrist Joanna Moncrieff who is a leading figure in the Critical Psychiatry Network, argues that we must resist biomedical explanations of mental distress in favor of economic and political ones. Ultimately, she believes that in order to tackle mental health issues, we need to tackle sociopolitical and economic problems because capitalism and the mental health system are fundamentally intertwined.

“The analysis starts from the position that mental health problems are not equivalent to physical medical conditions and are more fruitfully viewed as problems of communities or societies. Using the example of the United Kingdom, it traces how a public mental health system evolved alongside capitalism in order to manage the problems posed by people whose behavior was too chaotic, disruptive, or inefficient to participate in a labor market based on exploitation,” Moncrieff explains.
“The system provided a mixture of care and control, and under recent, Neoliberal regimes, these functions have been increasingly transferred to the private sector and provided in a capitalistic manner.”

a line of people waits that an arrogant banker finishes eating the planetScholars have long pointed to the mutually beneficial relationship between capitalism, market forces (including Big Pharma), and the mental health paradigm, which privileges individualistic treatments and biomedical explanations for human distress.

Many of these thinkers view mental suffering as impossible to disentangle from material realities and issues of power, wealth inequality, disenfranchisement, and other forms of social disadvantage. Even the United Nations has jumped on board with at least some of these ideas, proposing a move toward understanding mental health through the lens of “social determinants of health.”

The author of the current article has also written a blog post for MIA, exploring her article and some of its implications, which can be found here.

The current article analyzes the relationship between capitalism and the mental health system through a Marxist analytic frame. Moncrieff notes that there have been efforts for decades now to bring attention to how the mental health system supports capitalism and ultimately disguises social, political, and economic sources of distress by placing the onus on the individual or their biology. Despite that fact, the mental health-capitalism-pharmaceutical complex rages on. She argues that in order to make changes, we need to understand what’s happening from a materialist and economic perspective.

Moncrieff first notes that the quest for biological markers of mental disorders has failed to find convincing evidence and that there are numerous problems within these research programs:

  • “Genetic research with families and twins has overlooked important confounders, and positive findings have been highlighted while negative ones have been buried.”
  • “Recent genome-wide studies produce negligible evidence for any relevant genetic effects.”

She also notes that one of neurobiology’s most consistent findings—that people with schizophrenia have “smaller brains and larger brain cavities”—has been troubled by more recent findings that this is due, at least in part, to antipsychotic medications.

Rather than view these instances of human suffering as biological abnormalities or pathologies, she suggests that we try to understand them in context, as “problems of communities or societies.”

Noting the common argument that the mental health system exists to contain and control socially deviant behavior:

“Disturbed and disruptive behavior is not just a social nuisance; however, it potentially affects the processes of production that form the basis of modern societies. The individual who is acutely paranoid or severely depressed, for example, is unlikely to be able to work, or at least to work efficiently, and family members, too, may be prevented from working because of the disruption caused to their lives.
Moreover, someone who is severely mentally disturbed may frighten and upset those around them, preventing people from feeling secure and motivated enough to satisfy the requirements of labor, and potentially jeopardizing the whole system of modern production.”

In other words, it is not just a particular form of social tidiness or naked attempt at control that is at stake in wanting to remove “undesirables” and “deviants” from sight; but in fact, the mental health system has a direct relationship with capitalist economies and the labor pool.

Discussing the relationship between capitalism and welfare services, Moncrieff states:

“[It] contributes to the social reproduction of the capitalist system by ensuring that there is a supply of healthy, educated and disciplined workers.”

And that welfare services also function in a way that “ensures social harmony, by providing for the old and sick and sustaining those who will never enter the workforce, for example. [It] can be viewed as a means of legitimation of the system, since, by preventing people from dying on the streets, they ensure the continuation of capitalist relations of exploitation and domination through hegemony rather than force.”

On the topic of work conditions and worker satisfaction within capitalism, Moncrieff argues that people work harder under neoliberalism than they did in the past. Their “output” and “performance” are also “constantly scrutinized,” and of course, many people face high levels of job precarity.

She states that for these and other reasons, it’s no wonder that many workers are facing low morale, existing in a culture of “fear and blame,” and ultimately experiencing a number of distressing mental conditions:

“Competition, the basis of the capitalist system, creates winners and losers. Fear of failure is, therefore, a constant source of anxiety for the modern individual, and failure itself so often the precipitant of the demoralization and hopelessness that is called depression.”

The author concludes:

“This analysis suggests that the mental health system can be understood as part of a wider system of social reproduction through which modern societies produce a fit, capable and amenable workforce and ensure social harmony. The particular means of social reproduction depend on the economic and social form that each society takes.”
[…]
“The transformation of post-industrial populations into mental patients represents the economic and social marginalization of a large segment of society. Rejecting the medicalization of so-called mental health problems is a necessary step in revealing some of the fundamental contradictions of capitalism and laying the groundwork for political change.”

 

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Moncrieff, J. (January 01, 2021). The political economy of the mental health system: A Marxist analysis. Frontiers in Sociology, 6, 1-11. (Link)

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Micah Ingle, MA
MIA Research News Team: Micah Ingle is a doctoral student in Psychology: Consciousness and Society at the University of West Georgia. He has published on therapeutic approaches centering the person-in-context, as opposed to the individualizing medical model, and on the characteristics of people high in empathy. His current interests include the intersection of sociopolitical/economic structures and mental health, individualism in psychology, gender, liberation psychology, and mythopoetic perspectives inspired by Jungian thought.

19 COMMENTS

  1. I am glad someone has taken the time to summarize the important parts of Joanna Mongrieff’s recent blog. I will repeat the same comment I wrote at that time.

    “This blog is a very good overview of the history and the role of the “mental health” system in a Neoliberal capitalist world.

    BUT it does lack the necessary urgency needed to understand and respond to the current intensity of world contradictions within these systems that is placing the planet in great peril.

    And we must emphasize that this world is based on (and cannot exist without) the fundamental underlying principle of *exploitation* that is inherent within a class based capitalist society. AND this *exploitation* leads to ALL SORTS of stressors and forms of trauma that push humanity and the human mind to very extreme forms of psychological distress.

    This psychological distress is “medicalized” (and drugged) by psychiatry and Big Pharma in order to serve the larger power structure’s need to control and contain ANY form of disruption and dissent within the larger social order.

    The proliferation of psych drugging of the broader population, and the incarceration of “malcontents” within psychiatric prisons, has now become an absolute NECESSITY within today’s capitalist societies for its future survival. AND the high profit margins and growth of Big Pharma’s psych drug industry has also become an essential feature within the stabilization and growth of today’s capitalist economy.

    In today’s world the future of psychiatry (and their entire Medical Model), and the continuation of a class based capitalist system have an inseparable destiny. They are both totally interdependent, and CANNOT exist, OR continue on the planet without the other.

    All this has VERY important implications when developing strategies for trying to end all forms of psychiatric abuse in the world.

    It is essential when analyzing all the problems within the “mental health” system to make the very DIRECT connections the Medical Model has to the very existence of capitalism and imperialism in the world.

    To NOT do this, is to promote the ILLUSION that somehow we can reform psychiatry and their Medical Model, and we can also make “adjustments” to capitalism whereby it will magically become something it can never ever be – a fair and just society. You CANNOT ask (or expect) Dracula to suck water or some other liquid besides blood; he WILL NOT, and CANNOT exist without blood.

    With bourgeois democracies in the world facing imminent threats, along with the dire existential threat of climate collapse and inter imperialist nuclear world war, it is BEYOND THE TIME, when we must reevaluate alternatives to the class based capitalist systems of social organizations that will NO LONGER work (or exist much longer) on this planet.

    The first socialist experiments on this planet, which only lasted a mere 5-6 decades at best, MUST BE *reimagined* by summing up past shortcomings and mistakes. If we we fail to make these efforts, then the entire planet is doomed to destroy itself.

    Human nature has much greater diversity and potential than “dog eat dog” and “look out for number one.” This is the human nature taught and nurtured within class based capitalist societies.

    Human beings also have the capacity for high levels of cooperation and human compassion for others. Doesn’t the Russian invasion of Ukraine reveal to us both extremes of human nature? It is imperative for us to find the type of environment (and related societal structures) that allow the very best form of human nature to flourish and thrive in the world.

    Dare to Struggle, Dare to Win! Richard”

    • Desr Richard,
      The medical model doesn’t work at all (at any level). The psychotherapeutic model could also, be described as a bit of a time waster.

      I notice the Twelve Step Model seems to work very well for a lot of people, especially if they remain committed even after they gain a place in society.

  2. The reason that we have this Mental Health Industry and the Autism – Aspergers Industry is because we live in a society of advanced industrial and information technology, and so to uphold the Work Ethic and to keep the securities and real estate ponzi schemes going, we have to designate some of the population as scapegoats and pubic symbols and put them into medical internment camps.

    The alternative would just be to have Universal Basic Income, Public Housing, and Medicare for All.

    Joshua

  3. Countries are not run by voters they are run by corporations. The representative political parties work for the corporations they don’t work for the electorate. It’s not a question of “Capitalism” it’s a question of complete control.

  4. CA Governor Gavin Newsom is trying set up Care Courts so that he can put the homeless into psychiatric interment camps.

    I guess you could say that conservatives seem to operate on the Gilded Age Work Ethic Squirrel Cage model of society. Liberals, judging by Newsom, seem to operate on the Psychiatric Hospital Model of society.

    So the liberal model is really not that much different from the model the conservatives use, but it includes a provision for some people having a Brain Chemical Imbalance or a Neurological Difference, and so these people are given an exemption. But the way in which this is done is to subject them to a series of ritual humiliations and often to things which really destroy their consciousness, like neuro toxins or the transcranial magnet. Its not that different from what the Roman Empire used to use to make an example of someone, crucifixion. It makes these people into examples so horrid that they can maintain work ethic discipline in the rest of the society.

    Newsom’s support seems to come from groups of government employees and from those who are always the ones most bothered by homelessness, the real estate industry.

    And maintaining capitalism means maintaining the work ethic squirrel cage and this means maintaining the real estate and securities ponzi schemes.

    Joshua

    • Just to be clear, Joshua, with almost no exceptions, “conservative” representatives are just as supportive of incarcerating the “mentally ill” as the “liberal” ones. Big Pharma donates big money to both sides of the aisle. I agree that the rare politician who opposes such efforts will likely be on the conservative side, but the vast majority believe strongly that the “mentally ill” are dangerous and need to be locked up. In fact, one of the most common arguments against increased gun control based on mass shootings is that the “shooters” are “mentally ill” and should not be out on the street, hence blaming the shooter’s “mental illness” to redirect attention away from gun availability as a possible cause. I’m not meaning to hash out the gun control debate here, just pointing out that “conservatives” in general don’t give a half a hoot about the plight of the unlawfully incarcerated “mentally ill,” an even less so about the damaging scourge of mindless labeling and “medication” of millions of their constituents.

      • Yes, starting in the very early 1930’s, the FIRST people sent to the early “concentration camps” were the “intellectually disabled”, “mentally ill”, & criminals, before Jews as a group were specifically targeted….and Jews were far from the only ethnic groups.
        And, McCrea, you asked for this: Liberals, leftists, and Democrats, ALSO don’t give a damn about homeless mental patients. The World Capital of homeless dysfunction is liberal Democrap-controlled Californicate, which is quickly becoming an unlivable hell, thanks to the anti-God liberal leftist Democrats….
        I’m 1/2 surprised you didn’t break out in a chorus of “Orange Man Bad”, or “Cheetos-Cheetos”….
        I thank God I’m not stupid enough to be a “marxist”, or “freudian”…. I love people too much for that….
        When will you kids ever grow up, and LEARN? So-called “Marxism” is just another controlled-opposition control mechanism of the Global Ruling Elites & Global Banksters, – the “GREG B.’s”….

        • Don’t think I ever claimed that “liberals” and Democrats have done anything but support psychiatry’s agenda 100 per cent. Most “conservatives” support it just as much, of course, but any of the rare moments of resistance I have seen has come from the political Right, based on the idea of “government overreach” or protecting the rights of individuals. Still, their numbers are tiny, tiny, tiny, and the overwhelming majority of both parties are fully bought off and supportive of the pharma-psychiatric industry.

  5. It is well worth reading Dr. Moncrieff’s article. Below is a bit of what I took away:

    ” [Michel] Foucault suggested that the medical framework was superimposed onto the [psychiatric] system in order to give it the legitimacy associated with science… [He] referred to psychiatry as a ‘moral enterprise overlaid by the myths of positivism.'”

    Psychiatry “presents itself as a technical activity that is immune to political considerations.”

    “The medical nature of psychiatric terminology and knowledge obscures the values and judgements that are embedded in its practical execution.”

    “It enables interventions that are designed to curb or control unwanted behaviour to be conceptualized as medical treatment intended to benefit the recipient rather than the people who are disturbed by the individual’s behaviour.”

    “Underpinning the previously described functions of the mental health system is the idea that the situations concerned are medical conditions … and thus absolve individuals of responsibility for their own behaviour,and justify the forcible modification of that behaviour by others.”

    “The language of mental health … can be thought of, therefore, as an ideology in the Marxist sense that those concepts help to obscure real underlying tensions or concepts, and render the population amenable to viewing them as relatively simple, technical problems that should be left to experts.”

  6. Steve
    The shooters tend to be on “normal person” medication not “Severely Mentally Ill person” Medication. The shooters are generally Normal People that have gone Mad, NOT Severely Mentally Ill People that have gone MAD.

    …And the Problem tends to be that the Prescribed DRUGS have driven them MAD.

  7. Psychiatry is only one part of population abuse.
    The effect of the WAR in Ukraine will be to cause a Recession and a reduction in the standard of living in both Europe and Russia. Lots of People are not exactly needed and with information technology society can be easily controlled.

    • I’m pretty sure you’re not quite understanding exactly what the “depopulation agenda” is,
      and just how far along it is….
      The Global Ruling Elites DO NOT CARE about you & me, except to take a perverse pleasure in our suffering, which they impose on us every chance they get, by every means available….
      And it is STILL a beautiful world, and a beautiful life….
      I’m sorry for all those unhappy Marxists….

  8. As always, Dr. Moncrieff’s constant, persistent, clear voice gives me something that supports/parallels my experience…& gives me hope.

    Over a decade of being deftly ‘removed’ from my life by the diagnosis, smothering, damaging prison of drugs, & instant, permanent loss of credibility on any topic…I was able to blackmail my way to ‘safe’ withdrawal and removal of the ‘lifelong’ slander & SMI forehead tattoo…as a result of the prescriber’s mechanical error that couldn’t be placed at my ‘diseased’ feet.

    I was a deviant…
    A single, childless female (who wasn’t in desperate pursuit of a ‘remedy’) in my 50’s, living a creative, diverse path. I had all the ‘appropriately’ coveted stuff; beach house, nice car, good credit, great insurance…until I had a patch of insomnia regarding a business closure.
    HERE was an apparent ‘opportunity’ to ‘fix’ me which dovetailed beautifully with the Allen France$-led DSM-IV’s expansion of bipolar symptoms/diagnoses.
    The ‘professionals’ were convinced that my lack of a husband, children, career-in-a-cubicle, & substance-abusing parents = me being inevitably doomed-by my OWN hand, of course. THEY would ‘save’ me….How could I possibly be REALLY happy? I must be in denial.

    Of course I became a revenue & job creator for THEIR industry (Good girl!) AND successfully tranquillized/culled from the mainstream, so as not to infect others (women).
    The idea of being content and single was unfathomable to EVERY psych, psychologist, case-social worker and other industry parasites. Most were women.
    I was quietly deemed aberrant, delusional because I wasn’t lonely & enjoyed my own company…endlessly. So sad & clearly fatal without forced stupification.

    I am free now, but I carry my ‘change of diagnoses’ paperwork in my phone (NOS Anxiety…hahahahaha)…in case of a records leak or worse…my ‘papers’…like a Jew in 1940’s Nazi-land.
    As one new, ‘modern’ primary doctor responded when I ‘shared’….”That’s impossible”.

    Uh oh.

  9. Phil wrote,


    ” [Michel] Foucault suggested that the medical framework was superimposed onto the [psychiatric] system in order to give it the legitimacy associated with science… [He] referred to psychiatry as a ‘moral enterprise overlaid by the myths of positivism.’”

    I agree with what you and Foucault are saying about Psychiatry. But also note that it was only around 1960 that France started to offer Psychotherapy Licenses. And the first one in the entire country to obtain such a license was Michel Foucault. Needless to say, he later renounced his license and such practices.

    No amount of Psychotherapy will ever help anyone restore their social and civil standing. And the idea that someone needs therapy, healing , or recovery is just the anti-chamber to the entire mental health system.

    Joshua

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