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

Man — The Creator (1973)

From the August 1973 issue of the Socialist Standard

Man is a conscious being. He does not toss and sway with the forces of Nature; he is able to view his situation within the natural world and turn the earth’s resources to his own use.

From the time that the first crude tool was taken up until our days of powerful industry, men have gradually overcome the domineering influence of the external world and its processes.

Such a situation would certainly have been impossible if human beings were merely passive creatures acting as their instincts directed them. We are not like the honey-bee whose existence is purely a mechanical process directed towards reproduction and the continuation of the species. Men have the biological potential for creative behaviour and are able to learn and store a mass of information, and can utilize these abilities to mould life for maximum advantage.

People may even act in pure pleasure of creativity. So we see the artist and the writer, the scientist in his laboratory, the part-time inventor, women choosing pleasing and colourful food in an artistic manner, men training racing pigeons and building furniture for their home; all these are creative pursuits, far from the machine-like behaviour of instinct. Humans, with their dynamic abilities, are able to observe their existence, develop techniques that will ensure their survival, learn from the mistakes of their history, and change the organization of their society. All these features place man in a position of biological and social superiority over other animals.

The loss of purely instinctual behaviour in men means that there is no static “human nature”. Theoretically, the ideas, values and general behaviour that an individual develops are open. In reality, a child is born into a society and will learn the behaviour of the group surrounding him. However, no individual’s situation and experiences are identical and everyone acquires slightly different ideas. This promotes criticism, synthesis of thoughts, and new ideologies. Combined with technological advances, societies gradually undergo change. The relationship between ideas and the structure of society, and the manner in which ideologies alter, are extremely complex and cannot be dealt with here. Suffice it to say that ideas and technological developments which react upon society are themselves products of society, i.e. they are both effect and cause.

At particular times in history a change may be dramatic in comparison to the steady, but slow, alterations that normally take place, as was the case in the revolution from a feudal world of lords and peasants, based mainly on agricultural existence, to that of our capitalist world of property-owner and wage-worker, based mainly on industry and involving the competitive market system. The important point to note here, however, is that human nature changes with society. It is ludicrous to justify any society with its faults by saying that the horrors and inequalities are an inevitable result of the restrictions of man’s biological drives.

Indeed any study of anthropology will show a range of “human natures” across different cultures, which in their turn may be dramatically altered by the imposition of a foreign power. For instance, tribal societies may abhor competitive behaviour and “greed” but, once Western authorities impose themselves demanding taxes, their members may be forced to join the market to earn money, eventually becoming imbued with a competitiveness which had, at first, only been economic necessity.

Socialists oppose the unequal ownership of wealth that is intrinsic to the present organization of our society and which results in hardship for so many individuals. Technology has reached the stage where men can produce sufficient for everyone to live comfortably— if society was run on Socialist lines.

However, comfort is not enough.

Biology and history show that all men are creative beings who have raised themselves above Nature. Most creativity has been degraded under capitalism to the almost futile monotony of work, where the product of labour is taken from the wage-earner, whilst he is paid a pittance and other people reap in wealth without any active productiveness. We must demand to control and organize our own society. We must rebel against the indignity of being passive tools within a market system and being at the mercy of (usually incompetent and ineffectual) leaders. We must free our minds and free ourselves from a humiliating situation, and in doing so fulfil our potentialities as human beings.

Judith White

Are you anti-social? (1973)

From the January 1973 issue of the Socialist Standard

Returning on the train from Manchester the other day, desperately wanting to nod off to sleep, I was doomed to share a carriage with one of those creatures I dread: the incessant train-talker. To increase my woe, this monster began to discourse upon the nature of the world in such a manner that I felt obliged to attempt to clear up a few of her mistakes.

It all began with complaint about poverty, violence and anti-social attitudes — with which I truly sympathised. Then came that dreaded statement: “But we can’t change anything — it’s all due to human nature”. My heart sank and I felt a huge chasm suddenly open between my travelling companion and myself.

As the conversation continued I began to realise what a mass of muddles has arisen since the spread of Darwinism and the theory of evolution. Uniformed acceptance has moulded our attitudes to our fellow men and given us ideas of man’s social existence as ludicrously unmodifiable. Man is part of nature and therefore, it is often believed, he is involved in a fight for existence which is manifest violently in the animal world and in the battle between nations. In addition, part-time biologists postulate vague statements about “basic human nature” which is generally thought to refer to inheritable, instinctive behaviour lying deep in every human (since the time of the first baby homo sapiens), waiting to show its ugly head — which it is frequently supposed to do — in the form of unpleasant anti-social behaviour.

Such a view is based on a complete misunderstanding of the nature of both evolution and behavioural mechanisms. Evolutionary theory is concerned with group or species survival. Obviously, individuals are necessary for these group structures, but stress on the group is a prerequisite for a comprehension of evolution. A successful species is likely to be one that can adapt relatively easily to changing environmental conditions, and examination of the phylogenetic scale indicates that higher organisms appear to possess behavioural systems that give increased adaptability, i.e. they possess a greater capacity for learning with reliance on learned behaviour over purely instinctive mechanisms. Thus, in unicellular and other simple creatures, behaviour is largely due to involuntary and unmodified actions controlled by the genetic material of the organism and elicited with specific environmental stimuli, depending partly on genetic material but mostly upon past experience through learning.

The most dramatic example of this change through evolution is seen in the determination of sexual behaviour in animals. There are three factors involved: genes, hormones, and learning. In very simple creatures, sexual behaviour is controlled purely by the genes which determine whether the organism is male or female. With the evolution of vertebrates, it appears that genes determine the development of the male and female sexual structures, but that hormones secreted by these sexual organs become the important factors in the instigation of sexual behaviour. Hormones are greatly influenced by environmental stimuli and so provide a kind of monitoring system whereby reproduction can be stimulated in suitable conditions. As we pass further up the phylogenetic scale we see the development of better mechanism that allows for the adaptation of the species. In the higher vertebrates, especially primates, genetic material plays a minor part in the development of sexual behaviour (distinguished from physiological structure) and sex roles are determined by a social conditioning, i.e., through learning processes. It is well known that sex ascription will determine the behavioural pattern of the adult human despite the sexual structures so that, for example, a boy who is brought up as a girl will behave like a girl. (In certain cases the picture is more complicated, of course).

Paralleled with the progression from instinctive to learned behaviour through evolution is the development of affection and social behaviour. This is an important step as we see the direct organisation of individuals to ensure the continuation of the group or species. Man is a social animal and in addition modifies his behaviour continuously through learning.

My travelling companion was unaware that the factor that places Man at the top of the genetic scale is his ability to change. She was aware that she was dissatisfied with a world of violence, poverty and anti-social behaviour. Most people feel the same. The next step is to learn how to change the world so as to allow the satisfactory existence of mankind. This is well within Man’s capabilities.

Let’s get together as social creatures and organise our society as we would like it. Let’s have production for use not profit and at the same time remove the evils of war and excessive pollution that threaten to eliminate our species altogether.

Come on! Change for Socialism.

Judith White