Letter: ‘Mental Health: In a Mad, Mad World’ (2019)

Letter to the Editors from the October 2019 issue of the Socialist Standard

‘Mental Health: In a Mad, Mad World’

Dear Editors

In the September issue (‘Mental Health: In a Mad, Mad World’) you seem to give some credence to the theory that mental illness arises from a chemical imbalance in the brain and that antidepressant drugs work by restoring the balance. In your version of the theory the balance that needs to be maintained is that between serotonin, dopamine and oxytocin. The first two of these are neurotransmitters, the third a hormone; they perform quite different functions.

There are other versions of the theory. Often the theory is presented without specifying the substances that have to be ‘in balance’. The ratios that constitute ‘balance’ or ‘imbalance’ are never indicated. Nor is it ever explained why it is essential to maintain such ratios. Even if it were established that certain ratios among specified substances have to be maintained, no instruments exist to measure such ratios in a patient’s brain. There is no way for a physician to determine what quantities of which substances need to be added to achieve balance or check whether a drug has restored balance or just created a new imbalance.

Strictly speaking, this is not a theory at all but a poorly formulated hypothesis that is never proven but is endlessly repeated in order to convey the false impression that the biochemistry of mental illness is understood and sell the drugs that allegedly correct the imbalance.

The drugs prescribed for mental illness mess around with the brain in various complex and poorly understood ways. They may relieve distress by dulling all feelings, good as well as bad, but at the cost of serious ‘side effects’ and harm to the brain. Some drugs entail heightened risk of aggression or suicide.

Stephen Shenfield,

 (via email)

Reply:

We agree with much of what you say, and of course you’re correct to distinguish between a hormone and a neurotransmitter. But we’re not sure we’d want to throw all psychiatry – the treatment of mental health conditions with drugs – out of the window, given that many conditions, for example schizophrenia, are known to occur across family generations and therefore seem to have some genetic component. The article rightly argues that environment and biology are both factors.

The article states that mental health is the result of the correct balance of chemicals in the brain. You seem to reject this theory because nobody knows what that balance is, or even how to measure it, yet it seems to us that an optimal evolutionary balance must logically exist. We can’t see what you’re objecting to here. If there are stressful environmental factors at play, these will trigger ‘fight or flight’ hormones like cortisol and adrenaline which will in turn alter the brain chemistry. Conversely, if someone pops an ecstasy pill at a festival they’ll be flooded with dopamine and oxytocin hormones, and that will change their behaviour towards others. So environment changes chemistry and chemistry changes environment.

Of course it’s true that the chemistry of the brain is poorly understood, and that advances are achieved more by trial and error than by sound theory, but the same could be said of most branches of medicine, and even most branches of science. Some drugs have caused unexpected and disastrous side effects but that’s why the testing procedures are so long and complex, and we certainly wouldn’t want to reduce those in socialism.

The article’s larger point, with which you surely won’t disagree, is that a huge proportion of the world’s mental health problems, including epidemic rates of suicide, are caused directly or indirectly by the capitalist system itself, and that no amount of drugs is going to make that particular problem go away. 

Editors.

Marx, Engels and Science (2019)

Ray Lankester

From the October 2019 issue of the Socialist Standard

That Marx followed the progress of natural science can be seen from the fact that chemistry professor Carl Schorlemmer and evolutionary biologist Ray Lankester were among the nine who attended the private funeral gathering to mourn the passing of an obscure economic scientist whom Engels eulogized as ‘the best hated and most calumniated man of his times.’

Engels studied mathematical physics in many sources, including the classic eighteenth-century Traité de dynamique by Jean Le Rond d’Alembert (co-publisher with Denis Diderot of the great French Encyclopédie).  However, his primary modern source for mathematical physics was the Feynman lecture course of his day, the celebrated nineteenth-century Treatise on Natural Philosophy by Thomson and Tait (popularly known as ‘T&T’).

Engels’s primary modern source for chemistry was the celebrated Treatise on Chemistry by Roscoe and Schorlemmer. Those familiar with the Marx-Engels correspondence will have met organic chemist Carl Schorlemmer as a Marx/Engels comrade-in-exile from 1848 and their trusted scientific consultant.

The two treatises that Engels primarily studied happened to be the standard university textbooks from the mid–nineteenth century right up to the First World War.

Engels adopted a field (non-atomic) approach to electricity (of course, the electron had yet to be discovered, but so too had quantum electrodynamic field theory). To deprive Marx of an atomic theory is to ignore his PhD dissertation on Epicurus in which he famously defended Epicurus’s statistical atomic ‘swerve’ (a Greek pre-echo of quantum indeterminism) for allowing ‘free will’ to arise within a primarily deterministic atomic world.

Volume 31 of Section of Marx Engels Collected Works MEGA(2) [not yet translated into English] lets us glimpse the extent to which Marx took an active interest in the progress of natural science. A paper by MEGA scholars Somnath Ghosh and Pradip Baksi sets out the contents of Marx’s scientific notebooks of 1877-83:

Notebook 1. On the Atomic Theory
Notebook 2. Tabular summaries of inorganic and organic chemistry
Notebook 3. Tables of chemistry
Notebooks 4 & 5. Tables of inorganic and organic chemistry
Notebook 6. Formulae of organic chemistry

Marx’s Notebook Sources include:

• Chemistry: Lothar Meyer, Henry Roscoe, Carl Schorlemmer, Friedrich Kekule
• Modern chemistry: Marx attended August Hoffmann’s lecture course at the Royal College of Chemistry, London
• Agricultural Chemistry: Justus Liebig
• Physiological Chemistry: Wilhelm Kuhne
• Human Physiology: Ludimarr Hermann; Johannes Ranke
• Physics: Benjamin Witzschel
• Geology: Joseph Jukes
• Studies in electromagnetism: Edouard Hospitalier

Forthcoming natural scientific materials (perhaps now published) include Marx’s notes and excerpts on Physics, History of Technology, Geology, Soil Science, History of Agricultural Plants, Agricultural Chemistry, Physiology of Plants, of Animals and of Human Beings, parts of Mathematics and on the interrelationships of the Natural Sciences and Philosophy. One day we will discover just what the mature Marx actually wrote about the latter.

WJC

Cooking the Books: Not applying technology (2019)

The Cooking the Books column from the October 2019 issue of the Socialist Standard

In his book Fully Automated Luxury Communism Aaron Bastani quotes the US economist Paul Romer’s definition of technological change as ‘an improvement in the instructions for mixing together raw materials’ (he meant physical materials). He summarises Romer’s conclusion as that ‘over time, as technology develops, the value increasingly arises from the instructions for materials as opposed to the materials themselves’.

This is similar to what Marx, in ‘The Fragment on Machines’ in the Grundrisse, had said would eventually happen, with general scientific knowledge becoming a more important factor in production than direct labour. As this knowledge is a social product it’s an additional argument for socialism.

According to Bastani, Romer made the further point that ‘once the cost of creating a new set of instructions has been incurred the instructions can be used over and over again at no additional cost’. In other words, these instructions, once developed, could be available to be used for free in much the same way as digitised articles, books, films and music can be.

But there is a snag, as Bastani noted. This knowledge is privately owned and only made available by the developers to others at a cost – the royalty payments for the use of the patent. Some is even kept as a ‘trade secret’. Patents and other so-called ‘intellectual property’ rights are merely a legal fiction, applicable solely because they are entirely the product of a legal enactment, enforced by the courts and, ultimately, by the coercive power of the state.

Property rights over material goods are also a legal fiction, though not as blatant, as people can imagine more easily material goods being possessed in the absence of legal backing. On analysis, however, property in land, factories and other means for producing material things is not the same as physically possessing them. The owner of a landed estate does not physically possess the land in the same way that they possess their clothes or their car; nor does a capitalist shareholder. Their property rights have also been created and are enforced by the state.

The fact that scientific and technological knowledge has developed to the point where it could be applied to produce enough for everybody to be able to satisfy their material needs strengthens the case for socialism. It confirms that, whereas capitalism has developed the potential for this, it is incapable of activating it for the benefit of all. Capitalism has solved the problem of producing enough for all, but cannot distribute it. Only socialism can do this, on the basis of production directly for use, not profit, and distribution according to needs, not rationing through the wages system.

‘Fully Automated Luxury Communism’, as a description of socialism, is a deliberate exaggeration to dissociate the idea of communism from what happened in Russia with its shortages and queues. But it risks another misunderstanding – that socialism only becomes possible if there is ‘full’ automation. This would mean that it is still not really possible. This in fact is the justification that Bastani (and his fellow FALC advocate, Ash Sarkar) give for supporting the gradualism of the left-wing of the Labour Party. A better term, though admittedly not quite as snappy, might be ‘Highly Automated, Non-Austerity Communism’.

Top to Bottom (2019)

Book Review from the October 2019 issue of the Socialist Standard

Richard Wilkinson and Kate Pickett: The Inner Level. Penguin £9.99.

A decade ago the authors wrote The Spirit Level (discussed in the Socialist Standard for June 2009 and December 2010). There they showed how countries with higher levels of inequality also had more problems such as shorter life expectancy, more obese people and less social mobility. In this new book they extend their analysis to mental and psychological issues (see their website www.equalitytrust.org.uk for more information).

The main claim is that problems with a social gradient (those which are more common as you go down the social hierarchy, e.g. in terms of income) are more severe in more unequal societies. Thus the incidence of schizophrenia per head of population is higher in countries that exhibit greater inequality (almost three times as high in Brazil as in France, for instance). The more unequal US states have higher levels of depression. Generally, a greater degree of inequality can result in more social anxiety, which may itself be responsible for more problem gambling and risky alcohol consumption. Higher inequality can also make people more narcissistic, with an exaggeratedly positive view of themselves, which may again be related to social anxiety. More unequal countries show more bullying by children, fewer visits to art galleries and museums, and less civic participation (belonging to clubs of various kinds).

Inequality, then, is a bad thing, but it has not been a permanent feature of society: ‘throughout most of our specifically human prehistory, we lived in extraordinarily egalitarian hunting and gathering societies, in which food was shared and goods were passed between people’. Hunter-gatherers had no dominance hierarchy, and there were social constraints on alpha-male tendencies. It was the rise of agriculture that was probably responsible for the development of inequality. The social hierarchy which exists today is not the result of natural differences in people’s abilities; rather, any such differences are a product of this hierarchy since, for instance, the number of years spent in poverty can affect a child’s intellectual development.

As in The Spirit Level, Wilkinson and Pickett argue for a more egalitarian social system, or at least one where the degree of inequality roughly corresponds to that in the currently less unequal countries, where the incomes of the richest fifth are ‘only’ about four times higher than those of the poorest fifth. They argue that co-operatives and employee-owned companies can contribute to this and to the aim of a more environmentally sustainable society, with the challenge being ‘to improve well-being without growth’. There would be an end to consumerism, which is itself driven by status insecurity, and to wasteful consumption. The demands of work would be reduced, with greater leisure and so better health, both mental and physical.

The book is very informative about the extent and consequences of inequality, but achieving all that the authors envisage in a society still based on employment and production for profit would be a real pipedream.

Paul Bennett

Unequal society (2009)

Book Review from the June 2009 issue of the Socialist Standard

The Spirit Level: Why more equal societies almost always do better. Richard Wilkinson and Kate Pickett. Allen Lane, 2009.

The main theme of this book, as summarised in its subtitle, is that people living in less unequal societies almost always do better than those living in more unequal societies. This unsurprising theme is spelled out in the nine chapters in the middle part of the book dealing with the costs of inequality in various areas of life and society: community life and social relations; mental health and drug use; physical health and life expectancy; obesity; educational performance; teenage births; violence; imprisonment and punishment; and social mobility.

The first part of the book—titled Material Success, Social Failure—is an uncontroversial, even anodyne commentary on where we are now. Material success is a privilege of the minority: “the least well-off people even in the richest countries sometimes find themselves without enough money for food.”

Socialists are more likely to be interested in what the authors have to say in Part 3, A Better Society. Wilkinson and Pickett present themselves as good people with good ideas writing of the “need to create more equal societies able to meet our real social needs.” I particularly like the cartoon they reproduce of a rich, portly father explaining to his small son, “It goes in cycles, Junior. Sometimes the rich get richer and the poor get poorer. Sometimes the rich get richer and the poor stay the same.”

But the authors are really not as radical as they pretend. They like the charitable, friendly society, mutual, credit-union side of capitalism more then the openly profit-seeking side. They want a nice capitalism, not a nasty one. So when it comes to “what can be done?” they list reforms like “plug loopholes in the tax system, limit ‘business expenses’, increase top tax rates, and even legislate to limit maximum pay in a company to some multiple of the average or lowest paid.”

Stan Parker

Life Support (2019)

Book Review from the October 2019 issue of the Socialist Standard

Lee Humber: Vital Signs: The Deadly Costs of Health Inequality. Pluto Press £17.99.

What determines the health of an individual or of a whole population? Is it the healthcare they receive, or is it more to do with the conditions in which they live? Humber’s answer is that it is very much the ‘social determinants of health’ that affect a person’s wellbeing and life expectancy. Biomedical models focus on a person’s relationship with disease and the expertise of the medical profession, but a more multifaceted approach also looks at factors such as polluted air, overcrowded households, diet, and the pressures of employment.

Of course this does not mean that the kind of healthcare received is beside the point. One claim is that cuts in UK government health spending resulted in 45,000 more deaths among those over sixty between 2010 and 2014. In the US almost twice as much as a proportion of GDP is spent on healthcare than in the UK, yet life expectancy is several years less. About half of Americans can only afford the most basic health insurance, and 45,000 die each year because they lack health coverage. In spite of the importance of diet, GPs rarely ask patients about it.

One chapter is a critique of the ‘inequality thesis’ as set out by various authors. Humber claims that they rely too much on subjective notions such as status and social trust, and pay insufficient attention to social factors such as the quality of food. This overlooks the fact that Wilkinson and Pickett in particular rely on inequality of income as the crucial point, and there is no reason why an inequality-based approach and one looking at other societal factors cannot be combined.

It lacks an overall theme, and does not emphasis inequality as much as the subtitle might suggest, but Humber’s book gives a good picture of the deleterious effects of what others have termed the ‘medical–industrial complex’.

Paul Bennett

Inequality: Yachts and Diseases (2019)

From the October 2019 issue of the Socialist Standard

Huge numbers are hard to visualize. A billion dollars, let’s say. That’s the sum you have to accumulate to get yourself listed as a billionaire in Forbes magazine and denounced by Bernie as a member of the ‘billionaire class.’

Start with a wad of twenty $100 banknotes. That makes $2,000. Then imagine a suitcase packed with 500 of those wads. That makes a million. Then imagine entering a big storeroom with 100 of those suitcases lined up on shelves. That still gives us only one tenth of a billion.

Or we can tackle the problem in another way. We can ask what can be done with a billion dollars. What can be bought with that much money? What can be achieved?

Homes and yachts

Meet Mr Mukesh Ambani – chairman, managing director, and largest shareholder of Reliance Industries Ltd., a conglomerate that owns numerous firms throughout India. He spent one of his fifty-plus billions having a home built for himself, his wife, and their three children. With the possible exception of Buckingham Palace, it’s the priciest home in the world. Named Antilia after a mythical island in the Atlantic, it towers 568 feet over the smog-laden Mumbai landscape. Its facilities include parking space for 168 cars, a car service station, 3 helipads on the roof, 9 elevators, a spa, an ice cream parlor, terraced gardens, a temple, a vast library, a dance studio, a swimming pool, a gym, yoga room, and snow room, a ballroom, guest suites, a 50-seat theatre, and accommodation for 600 permanent staff. Ample use was made of marble, rare woods, and mother of pearl in the construction.

Another way to spend a billion dollars is to purchase a fancy yacht. If it hasn’t yet been snapped up, you could buy the Streets of Monaco, a ‘floating city’ that displays a miniature scene from the fabled principality. When it comes to yachts, however, a billion is not enough to take you right to the top. That place is occupied by the History Supreme, made of solid gold and platinum and valued at almost 5 billion dollars. It belongs to Mr Robert Kuok Hock Nien of Malaysia.

Trachoma

Searching for more ways to spend a billion dollars, I came across this news item. The World Health Organization (WHO), a specialized agency of the United Nations, had declared that it could eradicate trachoma within 4 years if it had a billion dollars to devote to that purpose.

Trachoma is a highly contagious eye infection. It scars the eyelids and turns them inward, so that the eyelashes scrape the cornea with every blink, causing great pain. Untreated, it leads to permanent blindness. Trachoma is endemic in many poor rural areas and affects over 21 million people, over a million of whom are already blind. However, the bacterium that causes trachoma is known. The condition is easy to treat, cure, and prevent.

So, says the WHO, it could eradicate this scourge if it were able to allocate $250 million a year to the task for 4 years. How much does it currently allocate for trachoma? Published data do not answer this question. The WHO’s Programme Budget 2018—2019 does not give figures for any specific communicable diseases except HIV and hepatitis (which are lumped together), tuberculosis, and malaria. Trachoma is placed in the category of ‘neglected tropical diseases’ (NTDs) alongside river blindness, leprosy, trypanosomiasis, lymphatic filariasis, elephantiasis, and dracunculiasis. This is not a complete list because ‘new diseases are constantly being added to the portfolio’; all low-income countries are affected by at least 5 NTDs (Section 1.4).

The amount spent by the WHO in 2018—2019 on all NTDs was $107.3 million. Of this $42.6 million was spent at headquarters, leaving only $64.7 million for work in the field, mainly in Africa and Southeast Asia. How much of this went to treat trachoma we do not know, but clearly it must have been far below the $250million required for eradication within 4 years.

This low level of expenditure reflects the chronic underfunding of WHO programmes by national governments. As one analyst remarks, ‘the WHO is required to function on a budget equal to that of the university hospital in Geneva [Switzerland] and less than the budget of many major hospitals in the United States.’ Hence also the pitifully modest targets that the WHO sets itself – for instance, to reduce ‘the number of people requiring interventions against NTDs’ from a baseline of 1,700 million to – wait for it! –1,500 million.

‘Neglected tropical diseases’ – that is not a medical term. Rather, it describes an economic and political situation. Pharmaceutical companies and entrepreneurial physicians neglect these diseases because hardly any of the people who suffer from them can afford to buy medical goods and services. As economists say, they create negligible ‘effective demand.’ And relieving their misery evidently comes very low on lists of governmental priorities.

Implications

The contrast drawn here highlights the cruelty and waste of a social system that caters with unstinted generosity to the trivial whims of a tiny minority while brushing aside the vital needs of millions of people. Many similar contrasts could be drawn. The sum of money could be larger or smaller. Instead of yachts we could talk about private jets. Instead of treatment for disease we could discuss the supply of drinking water (although that too is a healthcare issue).

It is not essential that comparisons be drawn in terms of money. Instead we could, for example, compare the numbers of people employed in socially useful and in socially useless work (money-handling jobs coming under the latter category). Money is not a very good measure of human effort and other resource use, even though in this society it is the most convenient one. Thus the value of Antilia on the real estate market has risen to two billion dollars, but this does not mean that the resources embodied in its construction have changed. Conversely, money values take no account of many very important resources.

Nor is it essential to focus solely on the luxury consumption of the wealthy. Luxury consumption is a significant and growing source of waste, but several other sources of waste are no less significant. Annual world military expenditure is rising toward the two-trillion-dollar mark ($1.822tn in 2018 according to SIPRI). There is also the waste inherent in unemployment and in built-in obsolescence, the waste of the creative abilities of working people, and the destruction of goods that cannot be sold at a profit.

A gloomy picture, to be sure. But it does draw attention to the vast scale of the resources that could be redirected to satisfy people’s needs and meet the climatic, environmental, and other global challenges faced by our species, once those resources are appropriated by the human community and brought under its democratic control.

Stefan

It's capitalism (2019)

Letter to issue 1280 of the Weekly Worker

Dave Vincent returns to the issue of foreign workers, claiming that nobody has answered his arguments against controlled immigration (Letters, December 12). I refer readers to only some of my own letters on migration and let them judge: March 20 2014; April 17 2014; June 18 2015; June 22 2017; July 6 2017.

Dave asks, “Do indigenous peoples worldwide have any rights at all over unprecedented numbers of those coming into their country without their agreement?”

Competition under capitalism leads to false ideas about the burden of newcomers to native-born workers, who claim first pick on ‘our’ hospitals, ‘our’ housing, ‘our’ social security benefits. In fact, bad housing, hospital waiting lists, low pay and bad working conditions are universal problems. They are a consequence of the essential poverty of all people who depend on being employed in order to live. There was never a time when life was easy. Migrants did not create the problems. They arrive here with the false hope of escaping the same misery in their home countries, but find when they arrive here they have to share it and take the blame for it.

Since its inception, capitalism has drawn workers from poorer parts of the country and from abroad to more developed regions in order to satisfy its labour needs. And, as Marx said, capitalists require to also build up an industrial reserve army for the bosses to maintain their dominance in the job market and to control wage levels. All those people migrating are simply obeying the imperative that they must try to find a place to work. No amount of restrictions will change that fact.

The resentment against migrants is a class matter and such prejudice is inflamed by the many sections of the ruling class. Capitalism has sometimes been against immigration restrictions by promoting the free movement and availability of wage labour. But, at the same time, the capitalist social system is a fertile breeding ground for anti-foreigner policies. This may seem like a contradiction, but that is how it is, for capitalism is riddled with contradictions and inconsistencies. It cannot be a system of human harmony - division and conflict are in its very nature. Capitalism is a ‘dog eat dog’ world and will remain so until it is abolished.

The solution to the immigration crisis lies not with building fences, but with creating the conditions that do not necessitate people leaving their homes, their family, their friends and neighbours. The reality is that the solution is socialism. In the meantime, instead of undermining the ability of migrant workers to cross borders in search of work, migrants need to be unionised, uniting migrant workers alongside local workers in a collective struggle to maintain and improve upon wages and conditions. As long as workers are viewing migrants as the cause of their problems, they leave themselves divided and distracted.

The concern of working people over wages, unemployment, welfare and public services is totally legitimate. However, placing the blame on migrants does not address the causes of these problems or bring improvements to the situation. The problem is the capitalist system itself. The path to beginning to solve these problems is workers’ unity across ethnic, religious and national lines. It is vital that the trade unions make the recruitment of migrant labour a top priority.

There is your answer, Dave, as painful as it is. No worker, solely by birthright, has a guarantee to a secure, decent life under capitalism. It is wishful, utopian thinking to believe otherwise.

Alan Johnstone 

Socialist Party of Great Britain