Policy Public health psychiatry Reading Systems

Is Mental Health Political?

Items neatly arranged on a desk, including a clipboard with a blank white sheet of paper and a magnet board with separate letters spelling "politics".
Photo by Tara Winstead

Here’s another piece in the New York Times’s series on mental health and society: Mental Health is Political. (Forgive the generous quoting and quotation marks that follow.) Dr. Carr says:

In medicine, examples of reification [the process by which the effects of a political arrangement of power and resources start to seem like objective, inevitable facts about the world] are so abundant that sociologists have a special term for it: “medicalization,” or the process by which something gets framed as primarily a medical problem. Medicalization shifts the terms in which we try to figure out what caused a problem, and what can be done to fix it. Often, it puts the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.

She goes on to say:

When it comes to mental health, the best treatment for the biological conditions underlying many symptoms might be ensuring that more people can live less stressful lives.

… after clarifying that she is

not arguing that mental illnesses are fake, or somehow nonbiological. Pointing out the medicalization of social and political problems does not mean denying that such problems produce real biological conditions; it means asking serious questions about what is causing those conditions.

The crux of her argument is this (emphasis mine):

This principle is what some health researchers mean by the idea that there are social determinants of health — that effective long-term solutions for many medicalized problems require nonmedical — this is to say, political — means.

I think I understand what she is arguing here: There are systems in our culture that contribute to mental distress and illnesses. I generally agree with this. If entry level jobs consistently paid wages that allowed people to rent apartments in cities where they work, that would reduce psychological pressure. The stress of long commutes, public transportation, and car and gasoline costs would disappear. People would have more time to enjoy healthful activities instead of commuting. If people are spending more on housing than they can afford, this leads to the tension of living paycheck to paycheck. Insecurities related to eviction and homelessness grow. None of this contributes to psychological wellness.

However, I also wonder how she defines “political” throughout this piece. Is all psychological distress really “political” in nature? For people who experience auditory hallucinations and delusions, is their psychological distress “political”? (Recall that there are people with a diagnosis of schizophrenia who are not indigent: They sustain employment, pay their rent on time, and lavish their pets with treats.)

Are all nonmedical interventions for mental illnesses—whether “medicalized” or not—“political” interventions? At various times and places, there has been alignment between the political beliefs of the community and those in political power. Did rates of mental distress and illnesses significantly decline? (I don’t know the answer to this; if you do, let me know.) If alcohol use disorders are mental illnesses, does this mean that Alcoholics Anonymous and other 12-step groups are “political” interventions? If people who have lost loved ones to suicide and convene as a group to express grief and support, is this a “political” act?

Should we still describe our psychological distress as “political” when life is inherently stressful? Is the act of commiserating with other medical professionals for support during the pandemic a political act? Maybe it is; maybe we must turn to each other because we recognize that health authorities apparently cannot and will not provide more support to us. But maybe it’s not; maybe this is a community of care we intentionally cultivated over time.

I found some validation for my reactions in this Gawker piece: Failure to Cope “Under Capitalism”. Clare Coffey describes

an application of “the personal is political” so expanded in scope that, for a certain kind of person, personal problems, anxieties, and dissatisfactions are illegible or illegitimate unless described as political problems.

She further notes that

[the] invocation [of capitalism] immediately establishes a phenomenon in the realm of the political, without any further work required.

… if only political problems are legitimate, only political solutions are admissible. This has the odd effect of filtering all attempts at self-integration through a political lens.

By describing problems (like capitalism) and solutions as political, perhaps this absolves us of the work we can (and sometimes need) to do. How can one person’s action have any meaningful impact on a political problem like capitalism? Aren’t systems, by definition, much larger than individual people? She then points out:

But in fact there is no one to adjudicate between you and capital, no one to say yes, that really is too much, let’s reassign this project. …

There is no political program that will release you from the necessity of doing more than you should have to or feel capable of doing, in politics as in every other part of life.

I appreciate her exhortation:

This is your life. You do not have time to wait for the revolution to begin living it. You will always be able to find someone to give you permission not to live it. But no one is coming along to live it for you.

To be clear, I am not at all suggesting that we can eradicate mental distress and illnesses by simply yanking on those bootstraps. The statement that “mental health is political”—to me, at least—removes any agency we have as individuals. Yes, political interventions and actions can improve population (mental) health. However, some political interventions will have little to no impact on individual psychological health. There are choices we all can make, on our own, that can help improve our own psychological wellbeing. Furthermore, we each can make choices everyday that can improve the psychological health of the people within our six-foot radius. Our actions don’t have to be political statements.

Given the work that I do, I don’t need much persuasion to believe that systems have many direct and indirect adverse effects on people’s health. It also seems unreasonable, though, that politics will always provide solutions for mental distress and illness.

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