Capitalism
to. The privatization of mental health has always been a state-sanctioned mechanism of social control. Thomas Szasz, who initially challenged the medicalization of sexuality, describes mental illness as a vague, inappropriate metaphor for problems in living, which are the expressed as symptoms. 23 Psychiatry analyses and treats these symptoms instead of the causes. Szasz of course distinguishes between mental illness and neurological disorders, such as Parkinson’s. The entire paradigm of mental health is based on one’s compatibility with the capitalist system; ‘good mental health’ is productivity within the system, and an unwillingness to participate is ‘bad mental health’ and therefore grounds to detain, medicate, or alter someone by other means so that they do participate. Disagreement with any element of the system is an individual problem in functioning that is analysed and remedied with whatever means necessary (for the individual’s benefit, of course). Sociologist Max Weber observes that all enterprises or markets within the capitalist system ‘must conform to capitalist rules of action’ or face elimination. Psychiatr y (and the medical care system) is not exempt, acting most like a competitive business in the expansion of its diagnostic classification system; to maintain a market, it must constantly enlarge the scope of problems it can address. 24 Neither is psychiatry exempt from the extension of the state’s authoritative power. In fact, Szasz asserts that psychiatry is a coercive instrument of oppression, due to the subjectivity of diagnosis and the power imbalance between doctor and patient. 25 Bypassing standard legal procedures, people who are deemed capable of damaging societal order can be held against their will in the interest of ‘wider society’ , which, as established, is the order of capital or colonial white-supremacist patriarchy. This idea of the current mental health system as a form of policing is compounded by the blatant racial discrimination of this process. In the year leading to March 2020, black people were four times as likely to be sectioned than white people. 26 These detentions can discredit both the individual and their ideas, for long after the period of detainment, in a method of (social) imprisonment that does not require walls. Punitive psychiatry has been practis ed since Samuel A. Cartwright classified black slaves’ desire to free captivity as a mental illness named drapetomania, for which the remedy was the removal of both big toes. 27 More recently, as Johnathan Metzl describes in his book The Protest Psychosis: How Schizophrenia Became a Black Man’s Disease , schizophrenia, once considered a non-threatening disease that affected mainly white middle-class women, became associated with the perceived rebellion and violence of black men during the civil rights movement, in a fear-based narrative that continues to pathologize and devalue black men. 28 An example among many is Aurora D’Angelo, who was sent to a mental health facility for psychiatric evaluation after participating in a rally in 1927 for Sacco and Vanzetti who were falsely accused of murder. 29 Another more blatant and contemporary example in the USA is oppositional defiant order (ODD), which Levine argues pathologizes anti-authoritarianism, particularly in youth. Diagnosis depends on symptoms that ‘interfere significantly with academic or social functioning,’ (which is effectively a summ ary of many ‘behavioural disorders’) caused by a ‘natural disposition or
23 Szasz 1962. 24 U’Ren 199 7. 25 Szasz 1962. 26 Detentions under the Mental Health Act [n.d.]. 27 Finkelman 1997: 305. 28 Metzl 2009. 29 Temkin 2009: 316.
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