Mental Health — a brief Critique by a Mental Hospital Worker (1973)

From the June 1973 issue of the Socialist Standard

If you are feeling the strains of life, if you are beginning to feel you cannot cope, or if you become aware that you see existence differently from other people, then watch out as you may find yourself in the clutches of a psychiatrist. Such characteristics may be considered symptoms of mental illness and, whereas you are free to accept or reject the advice of a doctor if you suffer from a physical illness, this right may be removed from you in the case of a disease of the “mind.” Although the 1959 Mental Health Act made treatment for mental illness on a voluntary basis possible, there are still over 10,000 individuals in Britain compulsorily detained in mental hospitals against their will. Beware unruly, aggressive behaviour as, if you are apprehended by the police, Section 29 gives leeway for you to be detained for 72 hours in mental hospital on the order of a mental health worker, temporarily overcoming the necessity of court action. Whether a short-term or long-term stay, the “care” of the individual in hospital involves the removal of control of life from that person; during that time existence will be regulated and regimented by hospital staff.

It is easy to fall into the trap of believing that what is being dealt with are “faulty brains” and that the “mental” person must immediately be guided totally by others before they cause damage to themselves or the public. However, we must look at the assumptions underlying this approach to insanity, the dangers to every individual in society arising from these assumptions, and also the power that medics have over the destiny of so many lives as a result.

Social Definition . . .

What is meant by “insanity?” The general model used is the medical one. The individual is said to be sick, with a disease of the brain. As a consequence the term "mental health” has been coined and this in turn results in a whole set of reactions towards the insane man or woman (such as sending them to a doctor who specializes in brains, putting them into hospital, and treating them with drugs or surgery) which are not necessarily correct.

This approach is often completely presumptuous, probably arising from the growth of psychiatry through the roots of medicine rather than psychology. Although “mental” behaviour may be an obvious result of brain malformation or brain damage (in which case the behaviour tends to be of a specific type), in a vast proportion of cases of disturbance, no physiological/structural abnormalities are to be found in the disturbed person. Classification of individuals as suffering from a particular mental syndrome is based almost completely on the individual’s behaviour, including responses to other people, the ideas expressed, the ability to hold down a job, and the patterning of results on “intelligence” tests. In other words, the definition of insanity is based on comparing individuals’ behaviour with the behaviour shown by the general population. So it is a social definition and cannot be the objective phenomenon that is claimed, but is subject to the prejudices and ideologies of the professionals involved in the field of mental health.

If the insane individual is the one who deviates from the normal what is meant by “normal” must be considered, as there is a great range of behaviour shown by members of society. Normality is behaviour that is generally tolerated throughout society, and the normal person is the one who has managed to survive in society with an acceptable balance between the development of his potentialities (including personality, intellectual and physical traits) and the conditioning by which his abilities are directed into socially acceptable functions (including such behaviour as being able to chat in the local).

. . . and Social Judgement

If, like Laing, you view the normal as sick (but see Socialist Standard, August 1972), what criteria have you for dealing with deviants from the “normally abnormal?” Bourgeois psychology indicates time and time again that present-day society is not one that permits individuals to fulfil their potentialities but one that inhibits people’s full development. Work by John Holt and Paul Goodman shows this process at work in the school setting where children’s creativity, inquisitiveness and desire to learn is progressively stilted as they become socialized to a regime that thwarts originality and praises tactics where “correct” answers arc provided without any understanding. This in turn reflects a wider conditioning where the “correct answer” is conformity to the requisites of capitalism; individuality means individuality within strict limits; to stretch beyond these is to become insane or criminal.

This is not attempting to exalt those in mental hospital, for their existence is often a miserable one. But questioning the very nature of normality and the conceptual — and practical — approach to abnormality exposes not only the inadequacies of the care for the “insane”, but also reveals a danger to every one of us. In Russia intellectuals are confined in mental hospitals and people are quick to condemn this. Yet this is only an extreme form of the attitude of those in the West: those who do not “fit in” must be locked away. Where are the boundary lines between the mad and the sane? Are you sure you belong to the population considered normal?

Let us consider those unfortunate individuals who find themselves in mental hospital. Removed from a bewildering world of insurmountable problems they may feel happier in the protected environment of the hospital where life is organized for them, where they only have to obey the staff. Alternatively, they may be further confused by their removal from a world they know to this strange environment. Whichever the case, evidence indicates that the longer the time the individual remains in “care”, the less chance there is of them leaving. For institutionalization works itself upon the inmates who, devoid of opportunities to run their own lives, learn behaviour that is inappropriate for the outside world and so become greater misfits. Goffman gives a good analysis of this process in Asylums and indicates how the inmate can be reduced to an obedient moron who is quiet and always follows the rules. From my own personal experience, when working in a mental subnormality hospital (in many ways identical to a psychiatric hospital), it was blatantly obvious that the person who attempted to assert himself in any way suffered great social recriminations and punishments with withdrawal of privileges. This type of individual, probably with the characteristics to survive better than other patients, is unlikely to be allowed out of the hospital by those in authority as they consider such behaviour to be “bad” — and so the hospital becomes a prison.

What's it all About ?

People “outside” show little interest in the mental hospital and, possibly due to this, doctors are left free to give E.C.T., drugs and brain surgery despite very inadequate knowledge of the consequences of these actions. The patient has no means of self-protection, and this is an uncaring society — which is possibly why many people are in mental hospitals anyway.

The problems are many and knowledge very limited. Certainly those individuals suffering from “mental syndromes” require support, care and understanding from the community in order to learn how to cope with life rather than to be rejected and locked away. But one cannot help being sceptical about this being possible in a society where most people are in some way “mentally sick”, which places so many pressures upon everyone that time is too precious to concentrate on helping “social inadequates”, and where everyone has a multitude of their own problems.

Judy

Out of Step . . . What Is 'Normality' In Capitalism? (1973)

From the May 1973 issue of the Socialist Standard

The governor of a large London prison is reputed on good authority to have said that if he were to unlock all the gates most of his prisoners would prefer not to walk out. This was of course a comment not so much on the prison as on the world outside. For one thing a prison accepts, or at any rate contains, attitudes and behaviour which are unlikely to be tolerated elsewhere. Prisoners are classed as among society's deviants; while they are inside they are subject to a social code which is geared to the needs of the prison and to what is required to survive there. Any prisoner who deviates from that code (for example the "grasses" — men who inform on others) act in ways which conform more closely to the requirements of the world outside the walls. 

This typically many-sided example serves as well as any as an introduction to the subject of deviance which in the time of drug use, homosexual reform, Women's Lib and so on is painfully exercising the minds of many workers who would probably feel more secure in unquestioning conformity. There are of course many fields in which deviance can show itself, not all of them connected with crime; madness for example. What they all have in common is an ability to provoke a general rejection of the deviants, which may lead to them being shut away — in prison, mental hospitals — or in them shutting themselves away (which may amount to the same thing) in their own circles of social contact. 

Deviance, the mainstream agrees, is bad — which means that normality is good. It is possible to spend a great deal of time in argument over a definition of normality, tossing about evidence from many fields — anthropology, history, sociology and so on. A psychiatrist may well have a definition substantially different from that of, say, a lawyer. There is no agreement about where normality is to be found — is it in an individual, a family, a community? Can prisoners really be classed as abnormal, when they themselves fit into a community with its own culture and morals? There is clearly more to this question than is to be found in the hysteria of the get-tough-with-criminals lobby. 

One solid fact we can deal with is that normality is socially defined and therefore socially violable. In other words, deviance is not a matter of scientific theory but of social pressures and expectancies; society at any one time decides who are the outsiders, not the other way round. Like any other social factor, the quality of normality — and therefore of deviance — changes in accordance with differing conditions and demands. For example, homosexuality was not so long ago considered one of the most abhorrent and threatening of deviances but now there is the beginning of a reaction against such bigotry. The result has been that there have been same minor changes in the law but, more importantly, there is a greater readiness among homosexuals to declare themselves and to organize in an effort to resist the special type of repression which is applied to them. There are stories that the true extent of homosexuality would be shocking news to Mary Whitehouse; that if it were revealed it would be seen to be common enough to cease to be deviant behaviour and, by sheer weight of popularity, almost to become normality (which would presumably transform our great stud heroes like James Bond into super deviants.) 

It would be useful here to give same attention to the norms — the social expectancies — which are imposed upon us today and which determine who and what is deviant. We must accept that in any social system minimum demands are imposed, which generally have to be met in order to survive. How does this apply to the capitalist society we live under today and what effect does this have upon us as social creatures? 

One of the first things we have impressed upon us is that our place in the economic order is to be employed for our living. As we grow up we are persistently cajoled into thinking about what we will do for a job when we leave school; to regard a top job with a desk and an office and a secretary and a company car as the climax of achievement. Our childhood, which is so crucial to our growth into adults, is cruelly distorted in the drive to turn us out as schooled and disciplined wage slaves, ready to do our part in capitalism's commodity production and to be driven slowly out of our minds in the boredom of an office or the drudgery of a production line. To deviate from these norms — to question the usefulness of wage slavery, to assert that work should be pleasure or nothing — is an offence against normality for which one of the lesser penalties is to be stigmatised as slothful. 

What is Required 

From our economic standing under capitalism we absorb social norms which are partly expressed in our family life and in the relationships between men and women. It is within the family that a significant part of the socializing of the child, adapting it to the requirements of capitalism, takes place, The family has its own expectancies — an invariably monogamous marriage, at its most fabulous a pre-ordained union of boy and girl to complete part of a great romantic jigsaw puzzle and go on to live happily ever after despite the Bomb and slumps and famine and the general rottenness of capitalism. Outside of the poorer magazines it never happens - and even if it did it would not be healthy. 

In marriage the expectancy is that the husband operates to a tolerance and to ambitions a lot higher than those of the wife. At its worst she is allowed the drab, unhistoric tasks at home, perhaps relieved by a teatime chat with another, equally confined, woman, or by a session of bingo, while he is away at heroic, vital deeds in the fierce world of commerce and industry. The family needed by capitalism is private, defensive; it denies free human contact and obstructs full living. And with all this, the family today is extremely fragile, with inadequate safety nets to catch those under whose weight the bough breaks. Yet so powerful is the conditioning of family dependence that to rebel against it may need to be an act of heroism — and capitalism can exact a high price for such courage.

These norms converge into the political expectancies of capitalism — the massive confidence trick by which millions of workers are persuaded that property society is normal and must go on for ever because it is based upon an eternal morality. Thus they continually opt for their own exploitation and repression, trusting in their leaders as wise, courageous men who will guide them through all their troubles to a safe and comfortable grave. They react derisively towards political deviants who insist that capitalism is no more than an historical phase, that it fails to meet the needs of its peoples, that leaders are an obstacle to our progress. Socialists are stigmatised, like any other deviants; we are dubbed agitators, cranks, impossibilists and we would not have it any other way. 

The concentrated personification of capitalism's norms is the smart young executive in his new town house, keeping a prudent eye on his stake in unit trusts, watching for the right moment to trade in his Ford for the latest model, paying all his bills, mowing the lawn whenever it is time and generally behaving as if he were only part-alive. This person can be seen in advertisments, in statistical returns and in some popular stories and plays. He may even, somewhere, exist for real. It is a relief to turn our attention to the deviant. 

Deviant from the Norm 

It is the lot of deviants to be rejected, which may conceal the fact that they are reacting in a way which is basically healthy, as a protest against intolerable conditions. The response to their protest is often anything but healthy, of which more later. For example a child who refuses to go to school may be tucked away under the deviant label, as "school-phobic". Yet it is often the case that such children are fearful not so much of what may happen to them at school as of what is actually happening to them at home. Nobody labels the family as "child-phobic", Drug addicts are often trying to block off the bleakness of capitalism yet they are dealt with as if they are the sickness in themselves. Many criminals are like those men who would prefer to stay in prison — capitalism offers them little in terms of concern, acceptance, esteem. Many of them bear the marks of a lifetime of social rejection, which has been intensified as they have kicked against it. At the end they are isolates, with little ability to form a relationship with even one human being, let alone with enough to enable them to win a place in the ranks of capitalism's wage slaves.

This is a process which has been expressed in a theory of primary and secondary deviance, which suggests that a first deviant act may provoke a response liable to produce another such act. A logical extension of this is that the agencies which set out to oppose deviance and to impose norms have the end effect of stimulating deviance. From this point of view the police, say, are seen as doing more, in a broad social sense, to promote crime than to contain it. At the same' time, by labelling a deviant as such society may be setting up the preconditions for repeat deviance — for example to stigmatize a person as mentally sick may induce fear in him and about him which can be expressed in disturbed behaviour — which reinforce the original labelling and so on. 

Can Society Care? 

The point at which this process might conveniently be said to start is often determined by the prejudices of stereotyping, by which one aspect of behaviour is presumed to determine another. Men with shoulder length hair, for example, are presumed to be on drugs; negroes all to live in ghetto conditions. There are elements of defensiveness in such labelling; anyone who feels the need to prove that he is not on drugs need only keep his hair short, and "while" people can wear their skin colour as if it were a badge guaranteeing civilized living. But another way, the normal actually needs its deviants, not just as the opposite side of a relationship but for the norm's protection, to define its position and to assert its acceptability. Deviance is insecurity and society at large can feel safer when it is reacting against it. By stigmatizing and shutting away its criminals and its mental patients society can take comfort from the fact that they are out of the way — and even call it treatment. 

An important point about capitalism is that its norms do not coincide with majority interests. Normality as far as capitalism goes is set and defined to assert and protect the superior standing and the privileges of the dominant, property-owning minority. It follows from this that it is virtually impossible to conform to the expectancies of capitalism; most people at some time have stolen, or slacked on the job, or breached the sexual assumption of the capitalist family. Capitalism's deviants are in the majority, which is evidence of the system's basic inability to organize itself to the advantage of its people. 

What, then, of the alternative society? Socialism will have its norms and so, it must be agreed, also its deviants. But those norms will be acceptable in that they will be laid down by the interests of the majority. Human beings will respond to the incentives of a co-operative, socially supportive system; even under capitalism, with the drive all the other way, deviants make pathetic attempts at winning acceptance. Socialism will be a society which will care. Anyone who then remembers the banished miseries of capitalism may end up by asking: where have all the deviants gone? 

Ivan