Psychiatric Hegemony: A Marxist Theory of Mental Illness

by Bruce M.Z. Cohen

This book offers a comprehensive Marxist critique of the business of mental health, demonstrating how the prerogatives of neoliberal capitalism for productive, self-governing citizens have allowed the discourse on mental illness to expand beyond the psychiatric institution into many previously untouched areas of public and private life including the home, school and the workplace. Through historical and contemporary analysis of psy-professional knowledge-claims and practices, Bruce Cohen shows how the extension of psychiatric authority can only be fully comprehended through the systematic theorising of power relations within capitalist society. From schizophrenia and hysteria to Attention-Deficit Hyperactivity Disorder and Borderline Personality Disorder, from spinning chairs and lobotomies to shock treatment and antidepressants, from the incarceration of working class women in the nineteenth century to the torture of prisoners of the ‘war on terror’ in the twenty-first, Psychiatric Hegemony is an uncompromising account of mental health ideology in neoliberal society.

Genres: Psychology, Nonfiction, Philosophy, Politics, Theory, Mental Health, Disability

258 pages, Hardcover

First published November 21, 2016

Reviews

[Sarah Cavar · Rating 4 out of 5]

an excellent resource for any mad studies student. Minus one star for taking a hard, uncritical, surprisingly social-constructionist view of psychosocial difference, despite supposedly being a materialist analysis. The social construction of diagnosis does not take away from the negative impacts (what’s known as) depression, etc have on peoples material realities.

The best parts of this book are it’s historicization of diagnosis and diagnosis-adjacent language in regard to institutions like the school and the workplace, including the trait of “shyness”/social anxiety. It’s consideration of ADHD and the pathologization of insufficient productivity were extremely interesting. I just fear it at times negated the realities of neurodivergence, instead pretending that surveillance and forced treatment are only unjustifiable if psychosocial difference is 1000% constructed.

What I want to see is a historically rich book like this that both acknowledges that yes, people think in different ways, and some people suffer experiences they’d rather not have, AND ALSO that those things do not negate peoples right to self-determination. Some of us aren’t “normal people” who are the victims of capitalism. Some of us are brainweird or crazy. And we’re your comrades too.

[Mykolas Yamakaitis · Rating 2 out of 5]

To be brutally honest, I’m getting very tired of reading critiques of the mental healthcare industry from authors who clearly have no personal interactions with the system and additionally, are clearly unfamiliar with any sort of disability studies. Though at one point, the author references mad studies (a subsection of disability studies devoted to mental illness, he clearly has not engaged with mad studies whatsoever).

I went into this book quite excited for the premise, especially as someone with serious mental illness who is considering pre-med to become a psychiatrist myself. Between other books I’ve read & my own experiences, I have strong feelings about the field of psy-professionals as the author calls it (he includes psychiatrists, therapists, social workers, etc. in this), & such psy-professionals’ connection with the prison industrial complex & policing as well as its tremendous failings overall.

My main issue with this book is that it comes across with the same energy as a paper written by a freshman undergraduate who only cites sources from jstor which agree with their argument and ignores all other sources and even obvious potential counterarguments.

Bruce M.Z. Cohen’s main argument is that psychiatry only serves the ruling class’ interest by pathologizing dissent and those who act outside of social norms (thereby challenging productivity). Therefore, he says, the field of psychiatry should be completely abolished. In my opinion, this conclusion makes little sense when considering those with serious mental illness (such as myself & also who he NEVER acknowledges as legitimate or in need of help). Cohen only discusses already controversial diagnoses such as borderline personality disorder (BPD), ADHD, and social anxiety disorder. He speaks of these as though they are the entirety of the psychiatric range of the present day. The fact that outside of the appendix, bipolar disorder is only mentioned 3 times (all in passing) should tell you all you need to know about the thoroughness of this book.

The exact moment the book completely lost me was when Cohen made the definite statement that “anti-depressants do not work.” While later he acknowledges anecdotal evidence that he has “friends” who claim they’ve been helped by medication, he has clearly misread studies. While it is true that some research has shown anti-depressants fail, when their use is isolated those with moderate-severe depression, they have proven tremendously helpful. Additionally, at no point, does he reference studies on anti-psychotics or other types of psychiatric medication, which I can personally attest to as life-saving. While I am more sympathetic to his argument that electroconvulsive therapy (ECT) should be abolished, I am hesitant to even take a stance on that, considering his other ridiculous arguments.

The rhetoric that there is no medical help for those suffering from mental illness is simply wrong and dangerous for those with serious mental illness. Therefore, I cannot support this book.

Some other issues I had w/ this book:

- The idea that psychiatry is used to keep the working class in line is extremely silly considering low income people have little access to psy-professionals (at least in the United States, I cannot speak for other nations in the global north which have better healthcare-allegedly). ADHD, which Cohen argues is used to keep young students compliant, is largely diagnosed in white males with access (due to their class status). Lower income students, girls, & especially people of color are usually simply dismissed as bad students or worse. They never receive the help they need (or they do, when they’re, like, 20y.o. —source: personal experience). I would come to the opposite conclusion of Cohen in some ways. I think more people need access to quality, informed psy-professionals and even medication. Many low income people suffer in silence because they cannot access a diagnosis or even just talk therapy.

- A weird moment was when Cohen used the Soviet Union, Cuba, and Maoist China as examples for his larger argument about the corruption and misuse of psychiatry. I suppose it sort of makes sense as he is arguing for the complete abolition of psychiatry but it came across as odd to me as he cites capitalism as the corrupting force for psy-professionals.

TL;DR: worth the read for people who are unfamiliar with the racist, capitalistic, & misogynistic history and present of psychiatry but as soon as the author starts making whacky arguments, consider asking your friends with mental illness what they think.

[Gabriel Avocado · Rating 5 out of 5]

fucking damning. im writing this from the perspective of someone who has been living with chronic mental health/neurodivergence issues nearly since birth. trauma of all sorts has shaped my psyche. im not saying this as someone who thinks medication is like, totally mind control man! im on medication, ive been on medication for 15 years, im in therapy and have been since i was a fairly young child (five or six i dont remember exactly). there has not been a single point of my life where i havent been in the care of psychiatric professionals, including presently.

now that we've got that out of the way, this book is a must read. fuck psychiatrists and fuck psychiatry. ect is monstrous. medication should be over the counter. full communism immediately.

i have really few complaints about this book. so the author treats western and capitalist as synonyms, which would not be an issue if in the same sections he talks about socialist states using psychiatry to control dissent. this is a huge contradiction but he never explains that said socialist states are 'actually capitalist' or attempt to explain how chinas psychiatric system is like the US's. its just weird because as good as his analyses are, they break down after you talk about how psychiatry is a tool of capitalism and then denounce the soviet unions psychiatric system or whatever. like ill accept that psychiatry is a tool of control, period, but specifying that its control for the sake of upholding capitalist order is like. i dunno man maybe i missed something.

anyway read this youll like it. its a must read.

[Ani]

i have such mixed feelings on this book. the contextualization of psychiatric practices as political and capitalist tools is great but it's need to invalidate the experience of mental illness and neurological difference rubbed me the wrong way. even if they were, as cohen insists, complete social constructions, they come with real, material consequences. systemic analysis is vital but so is looking at individual lived experiences! some people are wired differently and consequently perceive and navigate the world differently; this doesn't have to negate the fact that psychiatry has been used as a tool of oppression. even if my personal diagnoses were socially constructed issues, they affect my life now and i'm not going to just pretend they don't exist because scientists don't know the cause. i think it was still worth the read but take it with a grain of salt and do talk to some people with lived experience.

[riddhi]

i find it really difficult to rate this book, and would never recommend this to someone who's just starting out with either psychiatry, marxism, or gramsci. as someone who's multiply neurodivergent, i disagree with his entirely social-constructivist approach to psychiatry, and i will explain in detail why:

i strongly agree with the author's position and explanations of the deeply political nature of the institution of psychiatry and the intense harm it has caused to certain sections. it offers an extremely detailed historical analysis of the factors that shaped the formation of psychiatry as a discipline. however, it completely negates the experiences of those for whom the psy-sciences have been extremely helpful. it's extremely reductionist in how it conceptualizes the psy-sciences, with next to no mention of those who've lived through these experiences. it presents absolute statements as objective truths, which i've seen to be a common problem across marxist scholars and believers. the very nature of psy-sciences is one that mandates subjectivity across different contexts. as an audhd person along with other conditions, his stance on autism and adhd is highly questionable. those are not mere categories made up to control the population under a capitalist system, but very real, material conditions that disable people, no matter how many accommodations are provided or how much the society changes and evolves. i see no reason why my audhd won't be disabling even in a communist/socialist society, although the conditions of such disablement might improve because of societal relations and modes of production.

yes, psy-sciences are inherently political. yes, psychiatry has been used to demonize those at the margins. yes, psychiatry is born out of a system that's colonial. however, psychiatry has also helped people make sense of their experiences. psychiatry has aided people in 'healing', and 'recovering'. in the current society, whether you accept it or not, everyone does not have the privilege to unmask and be as they are. masking and unmasking, both are privileges. in many instances, this distress undergone by people is biological, it does have something to do with individual neurology, albeit not entirely. medication does work for a lot of people, although it has definitely also emerged as a whole pharmaceutical industry with unregulated prescription, forming a subcomponent of the mental health industrial complex.

it's also surprising to me that only a passing mention has been made to psychiatric liberation movements. in my opinion, such movements by the people should form a central component in explaining psychiatric hegemony. i see no effort by the author to highlight the advances made by these movements and how much they've fought for liberation. a historical analysis is incomplete without giving contemporary accounts and the present position of the science.

i really appreciate the detailed work put in the book, but it's as if the author deliberately ignores established facts and arguments that go against his opinion and his view of psy-sciences, presenting them instead as universal truths applicable to all. in this process, he's himself replicating what the dsm intends to do. i don't see the author's theorization as any different to those who support the dsm and the psy-sciences in the current form, for both call for certain statements as applicable to all, regardless of their contexts and backgrounds. if you know me personally, you'll be aware of how much i oppose the dsm and it's contents, and how much i've criticized the document and the discipline. however, in doing so, i cannot negate the experiences of those for whom the discipline has been helpful. i cannot take a unidirectional approach just to make sense of my personal position.

not so critical now, are we? for a staunch marxist like the author, maybe the use of dialectics would've been helpful in theorizing and making sense of 'psychiatric hegemony'.

[Kit · Rating 4 out of 5]

A radical book. The book does a good job of showing how the field of how 'psy-professionals' today are the direct inheritors of the practices of institutionalization and lobotomy.

Today we tend to think of anti-psychotics, anti-depressants and benzos in therapeutic terms, but Cohen shows that when they were first prescribed their purpose was control. Do we really believe that the situation has changed?

As someone who suffers from 'mental illness', I read this book urgently. I would recommend it to anyone struggling with the life of their mind.

No-doubt many will accuse Cohen of being an 'anti-psychiatrist'. These people missing the point. Much like the police, there is no reforming the psychiatrists. We clearly have to start from scratch.

[سیاووش · Rating 3 out of 5]

لطفاً بهم تبریک بگید، بالاخره این کوفت رو تموم کردم.
این کوفت توضیح می‌ده که روان‌پزشکی یه رشته‌ی «علمی» فارغ از ارزش نیست و در واقع یه ابزار مهم کنترل اجتماعی بوده و هست، که خیلی قشنگ توضیحش می‌ده، ولی خب می‌دونستیم. بر خلاف اسم کتاب، من مارکسیسم زیادی توی متن ندیدم. چیزی که کتاب ناگفته می‌ذاره اینه که خب آیا مرض روانی به کل تخیلیه؟ آیا اون کسایی که دارن ازش رنج می‌برن کشکن؟ اول کتاب می‌گه تجربه‌ی این افراد معتبره. ولی خب تجربه‌ی افراد دقیقاً توی گفتمان روان‌پزشکیه که معنا پیدا می‌کنه. حالا امیدوارم کتاب یارو راجع به مرض روانی رو هم بخونم و شاید اونجا یه نوری تابید.

[SpringInHades · Rating 3 out of 5]

While this book gives a good marxist analysis of the history and current political and sociological function of psychiatry. It fails to give an accurate view of the situation by ignoring the lived experiences of many neurodivergent individuals. It also straightforwardly denies neurological (not psychiatric) research on neurotypes such as autism and adhd.

Due to this, the author comes to the conclusion that psy-professions need to be simply abolished, a conclusion that ignores the need for people suffering from mental distress for help and the need for minority neurotypes to share knowledge bases for functioning in modern society.

It might be true that in a utopia where there are accommodations and education for each type of person en no on ever gets traumatized that we will be without a need for such people. But in reality every society I know of has some form of "Therapy" whether this is modern psychiatry, priests, mystics, shamans of simply a knowledgeable village elder. This need has always existed and we have always attempted to meet it to the best of our ability.

This is not to say that the criticisms in the book are not wholly true, but to suggest simply abolishing the entire profession and claiming it serves no real need, is a very privileged and naive solution.

I hope in future analysis of the profession, Mr Cohen will actually take some time to talk to some actual neurodivergent people.

[Cody Bivins-Starr · Rating 4 out of 5]

For Mad Studies, this offers some unique perspectives for sure. It’s less inclined toward the identity politics framework (blatantly so, hence the Marxist moniker), and does an excellent job challenging the notion that psychiatry is a value-neutral discipline. Likewise, the deep dives into history and their present manifestations is solid, especially the chapter on eugenics, capitalism, and mercy killing. Something which frequently bothers me about these discourses, however, is how they strongly connect the ideological forces behind eugenics but simultaneously remain uncritical of the present medical framing of issues like abortion and MaiD, especially around disability and mental health challenges. It seems like a severely limiting critique to say “did you know assertion of individual rights over the unfit life is eugenics?” but then to ignore the ways these complex entanglements manifest in ways which progressives in the US aren’t ready to admit.

Some of the conclusions here are quite overstated (the abolition of institutional psychiatry seems to me a bit unclear, considering there are forms of psych beyond the APA, WHO, NIMH frames.

[Authorized · Rating 3 out of 5]

Interesting and much-needed project, but full of problems.

In addition to an annoying number of typos, the arguments are full of holes, and contain a lot of one-sided circular reasoning and correlation-equals-causation "proofs" that feel lazy and rushed.

I hope this is more of starting point that can inspire further examination of and work about how the "psy-professions" and capitalism interact and reinforce themselves, than the last word on the subject.

[Micah · Rating 3 out of 5]

I am abstaining from rating the book. I think Cohen's project is admirable, and at the least, he's given me some other sources to check out. I don't think this book succeeded in its aim of examining psychiatric hegemony as related to late capitalism. It was more of an airing of psychiatric dirty laundry writ large. Valid, but not what was promised. Also, Cohen desperately needs an editor.

[Nathan Chamberlin · Rating 5 out of 5]

Very radically different view on Psychiatric/Psychological professions than what is mainstream. I was skeptical at first but after reading and looking into some of the studies I have to say that I don’t really see how you can view it any other way. It is absolutely bonkers that we have let psychiatrists and therapists get away with diagnosis’ that have no proven reliability or validity (obviously its not insidious or malicious on most of these individual’s parts). I have always bought into the biomedical view (chemical imbalances etc) because I assumed it was backed up but it seems I was very wrong. The use of mental health diagnosis as a means of social control over people, especially women, throughout history is shocking and though I’d like to think its different today, if you follow the thread of history and see how psychiatric “discoveries” seem to conveniently follow the progressing social norms (homosexuality being pathologized, slavery being pathologized, disobedient housewives being pathologized) its pretty silly to think that all of a sudden the mental health discourse is actually good faith and for the people.

The most interesting part that I’d love to do more reading on is the way neoliberal ideologies of the individual play into mental health. I’ve always thought the way we talk about mental health was a little sus, like the glorifying disguised as normalizing and the rampant self diagnosing but the chapter on this put my thoughts into a much broader context. The neoliberal urge to put the blame on your failing on yourself while ignoring systemic issues plaguing you is indeed very present in the way we police our own conciousness for symptoms of various “diseases”. With all these diseases being ways in which we deviate from the obedient ambitious worker with a complete lack of class conciousness or discontent for his position in society. This is also ever present in the pervasiveness of the self help industry and hustle culture obviously. I would be very curious if there is a link to this self policing for “what is wrong with us” has something to do with the apathy towards societal issues that I see in many people because sometimes it feels like this apathy is justified in the name of self care.

The one thing I wish he would have included was a short section on individuals dealing with mental health issues. It kind of comes across as invalidating mental health struggles even though I think he is just trying to keep the book to the facts of science/history. The book qwould be a lot more palatable if he would have included a little blurb that says something like: While mental health diagnosises may be socially constructed and have no biomedical validity, individual people’s struggles and pain are still real. These struggles are simply being co-opted by the mental health system to steer people towards conformity to their standards”

Anyways banger book y’all should read it!

[ashes ➷]

sometimes you read a quote on tumblr that just slaps you upside the head idk

[sıla karaman · Rating 3 out of 5]

Uzatti

[victoria]

I feel ambivalent … the author outlines the problems with psychiatry as an institution well but is still prone to a kind of sanctimonious tone—i.e. this book is best read if you’re already partial to the arguments being made, which is frustrating bc it’s intended as an intro. and of course the section for next steps is maddeningly vague and idealistic. that said, there are interesting and compelling points in here and it did make me think deeply about the function and value of psych etc etc

[Annie · Rating 4 out of 5]

Very solid Marxist analysis of the political economy of psychiatry as well as its function as an ideological state apparatus. If you're already familiar with such anti-psychiatry arguments, then this book probably won't be anything too groundbreaking, but for skeptics or people who are not as familiar with Marxist analyses of mental health, then this is a really great foundation that covers a lot of historical and theoretical ground.

Even as someone who has long been critical of how mental health is weaponized in capitalist society, it surprised me to learn that there is absolutely zero established etiology for any so-called mental illness. It just goes to show you how ingrained the discourse is in our society that I took for granted the idea that, surely, the 21st century psychiatrists must have figured out something, right? For the field to be 100% bullshit was kind of startling. Although I wonder if there's an epistemological discussion to be had about the assumption that the Western biomedical model of disease is True and psychiatry fails because it cannot meet that standard..

I also enjoyed the discussion of how psychiatry helps produce and reinforce neoliberal subjectivity—not only in the sense that psychiatry individualizes social problems and squashes dissent but also in promoting self-surveillance, self-diagnosis, and self-monitoring (which spills over into people "diagnosing" each other with the language of psychiatry). I felt that this part was especially relevant to today's mental health discourse where depression and anxiety used to be the catch-all (self-)diagnoses and now it's ADHD and autism.

The discussion towards the end of the book about how the American Psychological Association colluded with the American state post 9/11 to torture people and wage psychological warfare on so-called "terrorists" was especially damning. For some reason, I had never made the conscious connection between torture/psychological warfare and the institution of psychiatry. But reflecting on it, it's a perfectly natural collaboration. The fact that the APA, hand in hand with the CIA and the Pentagon, revised its own code of ethics so that it could participate in these tortures was astonishing. I understand why this information is suppressed, but at the same time why don't people talk about this! Between German psychiatrists exterminating the "unfit" before, during, and after WWII and American psychologists torturing prisoners at Guantanamo Bay, the whole institution is damned. And all this because psychologists wanted to gain "prescription privileges"? Incredibly sinister and really speaks volumes about the power/control associated with administering psychoactive drugs.

[Jeremy · Rating 4 out of 5]

This book gives a strong argument towards the notion that psychiatry isn’t distinct from other institutions in its hegemonic characteristics and in fact, is one of the most important tools at the ruling classes disposal to depoliticize mental health and delegitimize any sort of resistance to the status quo. This goes not only for neoliberalism but all forms of economic/political/social status quos, from the Soviet Union to Nazi Germany. Psychiatry in the modern day, this book argues, is an extension of the ruling class that works to shift blame for societal woes from the system onto the individual, laying cover for drastic inequalities apparent in contemporary society. This book also argues that psychiatry as a field has been based on subjective ideas of what constitutes “normal”, instead of what is scientifically accurate information. Studies from different time periods have classified “social deviants” as those who were homosexual, who masturbated, who were rude while being female, who had learning disabilities, who didn’t like people a slave, and who didn’t like being colonized and were used to justify oppressive treatment of individuals and even genocide.

While I do hesitate that one must not extrapolate, as this book does, to say that the whole field of psychiatry is useless because of its shady past (and present in cases of electric convulsion therapy) and it’s obvious usefulness to the ruling class, this book does offer a damning critique of psychiatry that should be taken seriously.

[TheNomad · Rating 5 out of 5]

Very interesting. I don't know what to think of it exactly because a lot of what it says is controversial. Some things, like the historical aspect of it all, seemed well-researched and made sense. The more modern aspect is something I'm not so sure about. It's definitely "out there" in its conclusions, though it does line up somewhat with Marxist theory, though the opposite of the conclusions could easily line up with Marxist theory as well. I definitely would recommend this to anyone that wants an outside perspective on the psychiatric profession in general and one that's more critical of it under capitalism, including the bio-metric model to mental illness, among other things.

Not sure what else to add because I wouldn't want to give away necessarily what the book says because it really should be experienced by the reader. So good luck on getting a good takeaway from this book, if you ever do read it. I would at least give it a change just to see what you think as it's a short read.

[Elari · Rating 4 out of 5]

The title of this book is a reference to Antonio Gramsci's concept of hegemony -- one of the most fascinating concepts of Marxist theory. The general argument is that psychiatry has imposed itself as the dominant discourse in society (under the blatantly false pretense of scientific truth), so that no aspect of life can be thought of in terms not encompassed by the psychiatric vocabulary. Cohen discusses: political economy; neoliberalism; compliance in the workplace; the medicalization of deviance in youth; women and patriarchal relations; and political dissent. He concludes that "despite having some psy-professional friends and colleagues whom I continue to work with on various research projects, I would at this stage be a fool to recommend anything other than the wholesale abolition of their profession. This is the logical conclusion from my research and theoretical argumentation in the book." This is not necessarily my opinion, but I still think the book is an eye-opener.

[David · Rating 5 out of 5]

Well, I wasn’t expecting this to be the most disturbing book that I read all year but it certainly was.

It raised a lot of deeply uncomfortable questions, and everything about psychiatry and Germany was worse than I could have possibly imagined. (Not that psychiatry was doing stellar work everywhere on the racism and social Darwinism front, but wow, the absolute horror).

I think his analysis would have greatly benefited from a trauma based approach to mental health which would still have not detracted from his argument-it seems at time that the author is arguing that mental health issues do not exist, but as a psychiatric nurse, they definitely do, and the underlying etiology is very commonly trauma, which is exacerbated by what? SES, marginalization, and oppression.

[Maddan · Rating 5 out of 5]

Extremely impressive and well-stated critique. Cannot believe how consistently and clearly Cohen managed to link the concepts he dissected, from beginning to end the book felt absurdly coherent and shockingly digestible for such a complex topic. I especially liked how Cohen linked the rise of modern medication to neoliberal ideology and his analysis on how the psy-professions justified horrors in the past. Again, the clarity with which Cohen talks about these extremely difficult subjects is absurd to me.

If Goodreads let me rate books by half stars I’d give this a 4.5/5 because it is not quite perfect, but my (very few) criticisms are so minor that I will instead not write about any of them and round my rating up to 5. Excited to read more by the author

[Jody Anderson · Rating 5 out of 5]

At times could be more fleshed out and extensively argued, but overall a well-written introduction that will change your whole understanding of the psychiatric field if you (like me) have not read much critical theory on the subject. The thesis is very radical (that psychiatry as a whole hasn't been coopted, but rather is itself a non-scientific arm of social/political control), and the proof may seem sparse at times for such a significant claim. However, when writing a text like this you must walk a line between extensively proving your claim and overwhelming the reader in length. I'll definitely have to read more, but I think it's convincing enough for me based on what else I've seen and read.

[Nicholas · Rating 4 out of 5]

Not this book telling me that my career is complete bullshit.

But actually, I think this book should be read by anyone who wants to critically reflect on psychiatry/ mental health professions and their role in upholding capitalism.

While a lot of the points made in this book were "yeah, duh" kind of takeways, the writing was really pretentious, and therefore, I feel accomplished having read it. And with that being said, the writing was so obnoxious that no one should read it. Just wait for the movie

[Dua Khawaja · Rating 3 out of 5]

As a Marxist analysis of the current state of the mental health industry, this book makes some valid points, but it also ventures into a somewhat murky waters, especially given how mental health issues remain taboo in many ways. That said, it's a good read if you're interested in understanding capitalism and its impact on pretty much everything.

[Taliah]

dnf simply because this long as hell

[John Davie · Rating 5 out of 5]

Stalin was once asked which was the worse deviation from communism, the leftist deviation or the rightist deviation? He replied "both are worse."

Today's capitalist ideology creates an artificial bipolarity when it comes to critical issues. Politics is the obvious example, Liberal or Labor, Democrat or Republican, both have the same unlimited faith in Capital and 'the market.' Both are worse.

Such is the discussion when it comes to mental health. Most discussion of mental health in society inevitably results in the conclusion, 'we aren't doing enough' we need more psychiatric intervention, more money for psychiatric clinics, more psychiatric help in schools, businesses need to invest more in mental health...etc. This is opposed to the alternative of 'the costs are too high,' children these days need to toughen up' or whatever. This is another case of both are worse.

Cohen using the marxist dialectical materialist approach, draws on Gramsci and builds on Szasz', groundbreaking book; The Myth of Mental Illness. It's absolutely critical to point out that neither Cohen nor Szasz deny that people suffer real psychological stress. What Szasz says is that most of this stress is caused by what he terms; 'problems of living.'

Cohen picks up from this strand which I think Szasz leaves dangling in the air. Psychiatry pathologises certain behaviours that are detrimental to capitalism and labels them mental illnesses. This has a double purpose. The first is to give the semblance of a 'scientific' 'objective' justification for the persecution and in many cases liquidation of the 'unhealthy' anti-capitalist attitudes and behaviours. The second is to personalise all the tremendous harm that capitalism does to people into an individual pathology, (the issue isn't the rigid totalitarian power structure you work under, it's an inadequate coping mechanism).

We see this in the changing nature of the DSM to suite the needs of capital.The DSM-5 for instance directly borrows the language of neo-liberalism to label "decreased productivity and efficiency at work, school or home" as one of the 'symptoms' of Premenstrual Dysphoric Disorder (PMDD, todays version of feminine Hysteria).

Cohen calls for the abolition of the psy-professions altogether. I think this is perhaps a bit much. But one has to consider the enormous damage psychiatry has done. Lobotomies ruined countless lives, and arguably continue in a modified form with procedures such as electro-modulation and in a very plausible way in the form of psycho-pharmaceutical drugs (as lobotomies became unpopular and institutionalisation too expensive psychiatrists moved to drugs as a form of chemical lobotomy). And electroshock therapy unbelievably still continues to this day.

Many of you may have received an email from your work along the lines of 'mental health awareness month' or 'are you ok day' or something else. You should be extremely suspicious of anything that HR is trying to push and this is no exception.

"Contrary to what our mangers are telling us, the infiltration of psychiatry and allied professions into our work lives is not a progressive step in the health field, rather it signals the cover surveillance and social control of labour under neoliberal conditions."

[Claire · Rating 3 out of 5]

Watched Poor Things and finally finished reading this on the same night ...💭💭