How Capitalism is Responsible for the Mental Health Crisis?
The for profit healthcare system in America has been pulled into the spotlight in the wake of the COVID-19 pandemic, with many questioning the efficacy of private insurance as co-pays and fees continue to make health related visits inaccessible for a large percentage of Americans. Over the first year of the pandemic alone, The Century Foundation reported a spike of 31.4% of adults experiencing moderate to severe anxiety. While the solution to the mental health crisis seems obvious at first glance, making healthcare free and accessible to everyone, it would only be the first step. Suicide rates have been increasing for years even prior to the pandemic, despite an increase in mental health apps, psychotherapy, medication, hotlines, and after school specials. The mental health crisis will not be solved without systemic change that targets the conditions exacerbating mental illness for those most disadvantaged, including the way we treat mental health, the economic coercion of labor, and the very culture of individualism that is natural to capitalism.
The true issue with healthcare under capitalism is not only that it is privatized, but it requires profit margins that ultimately hinder treatment. For-profit psychiatry has taken a biological approach to mental illness: dividing subjective mental states into definitive categories and even emphasizing systemic definitions of success as a benchmark to measure mental wellness. The DSM has been used to categorize what is "normal" and "abnormal", even in responses to external stressors, strengthening "the idea that failure to succeed in the dominant society is an individual problem that must be corrected by individual treatment" (Zeira, 7). This, in turn, promotes the idea that an individual's conditions are determined by genetics, rather than outside factors. It is a hauntingly familiar tale, and used historically by eugenicists in justification of horrors such as the holocaust, slavery, and colonization. It has been clearly proven wrong in numerous bodies of research. Responsibility for these conditions is then diverted away from those with all of the power or wealth, and instead obstacles such as homelessness, poverty, incarceration, and mental illness are all faults of the individual, rather than the system. As Richard U'Ren describes in his article on Psychiatry and Capitalism, Psychiatrists are meant to look at general symptoms as a method of classification, emptying them of any sort of meaning and effectively decontextualizing the individual. Psychiatry capitalizes itself by classifying symptoms as a problem only it can solve, then studying these "abnormal" symptoms, particularly in those that are not "productive". He states, "In these ways, a traditionally non-productive group of people - the "mentally ill", many of whom are unable to work in the usual ways - get drawn back into the productive cycle of capitalism". But what is the efficacy of this methodology? Is this productivity necessary for the individual, or for the state?
Biological psychology is reinforced by its high profit margins as it focuses on medicinal care. A common critique of the American healthcare system is that "a cured patient is no longer a customer".Adderall is widely prescribed for its positive impacts on productivity and focus despite having no known long lasting benefits, and despite its addictive quality. It was initially advertised by pharmaceutical companies as a drug to "fix" rowdy children, and is increasingly used by college students and office workers who "just can't seem to focus" on workloads that get increasingly larger. It has a detrimental effect on muscle mass, appetite, and sleep; also triggering eating disorders and manic episodes."A profit-based health system by definition develops only those treatments that are profitable, and makes them available only to those who can pay. In strictly monetary terms, it is more profitable to treat disease than to prevent it; it is more profitable to deny treatment than to provide it; and it is more profitable to limit services to the less seriously ill than it is to treat the more seriously ill." (Page, 51). Adderall is often seen as a miracle drug for those that can pay for it, and it offers a lot of money to the Psychiatrists and Pharmaceutical companies that provide it, but it's not designed to actually better the lives of the people that suffer from ADHD. It's designed to make people more productive (and it works in that regard extraordinarily well). Anna Zeira, a resident Psychiatrist at the University of Maryland explains that medication is offered as the primary solution, and advertised as a way to be more competitive and successful (8). The benchmark of productivity is all that is allowed to be seen as the benchmark of mental health, which lends to the theory U'Ren prescribes that the individuals that are not productive are broken and must be fixed.
Emphasis on profit margins not only hinders treatment but leads to improper and even harmful treatments as well as inadequate or flawed diagnosis."The pharmaceutical industry worked to link the DSM descriptive diagnoses to biological abnormalities and began to promote biological psychiatry by investing in public health campaigns, funding individual psychiatrists supportive of the biological approach, and financing nearly all clinical trials into psychiatric medication. " (Zeira, 8). Profit incentive was the only motivation for the focus on biological psychiatry, despite evidence that it may not be effective in the long term. This is not the first example of scientific failure in mental health, nor is it the first example of unethical and oppressive practice in psychiatry. Rates of Schizophrenia in African American males during the civil rights movement increased dramatically during the civil rights era as psychiatrists at the Ionia State Hospital described those who spoke out about racial injustice as "delusional" or "paranoid" (Zeira, 8). The DSM once classified homosexuality as diagnosable disorder (Page, 51).
Even Psychiatrists and Psychotherapists who have a genuine interest in improving overall mental well being struggle to do so under a Capitalist system. Linda Page describes the positions that Psychotherapists are being forced to take in prisons and corporations to pay their own bills:
In prison, psychotherapists are expected to facilitate control and containment (which are covered in prison budgets) rather than provide treatment and rehabilitation (which are not)... Corporations employ psychotherapists to undermine existing unions, prevent the formation of new unions, and make layoffs and cutbacks more palatable... corporate psychology serves to personalize structural problems and defuse worker discontent" (52)
Anna Zeira explains a more serious issue that goes beyond the for-profit design of our healthcare system "Unfortunately, as providers, individualized treatment with medication and psychotherapy are often the only options we're able to offer because modifying a person's social environment and changing policy is outside of our capabilities in the clinic" (8). Ultimately, even with excessive healthcare reform focused outside of profit itself, individual treatment (or even group treatment) will never fix the conditions that cause mental illness to develop.
Capitalism still has a dangerous effect on the methodology for treating mental health. The rise of mental health apps has been criticized as another facet of surveillance capitalism, where companies mine their user's data not only to sell, but to study as a means to manipulate social norms. "We can engineer the context around a particular behavior and force change that way... we are learning how to write the music, and then we let the music make them dance" (Cosgrove, 8). This is an example of Hacking's looping effect, where the development of a new classification (or multiple classifications) causes the individuals being classified to slowly conform with and identify with the classification, attempting to align themselves with what they believe they know. "Casting behavioral surplus data in the seemingly objective and scientific language of mental disorders may thus serve to legitimate and naturalize psychiatric classification systems, while simultaneously shaping the behavior of the person using the app towards the demands of capitalism." (Cosgrove, 8).
Working class people are economically coerced into exploitative labor, which can create or worsen mental health issues. Many working class people are forced to work two jobs to simply keep themselves alive as the federal minimum wage has not increased since 2009, despite inflation increasing the value of the U.S. dollar 29.56% since 2009 (U.S. Bureau of Labor Statistics). And it's no wonder that homelessness is another leading issue in the United States, as the average sales price of a house has increased much faster at 76.38% since 2009, reaching an average of $453,300 today (FRED Economic Data). 11.4% of Americans were classified as living in poverty in 2020, and the percentages got higher for each younger age group (Income and Poverty in the U.S. 2020). The wealth gap continues to grow, and disparity continues for marginalized groups. It's no secret that poverty negatively impacts mental health, and the research exists in heaps.
Workers cannot expect to find a high paying job without a bachelor's degree, but tuition is higher than ever, preventing adults already coming from poverty from getting an education. Between 2010 and 2020, the average tuition increase at 2-year colleges was $1,005 or 41.2%. Adjusting for inflation, the cost of tuition has increased by $7,502 or 361%. From 1989 to 2016, college costs increased almost 8 times faster than wages. (educationdata.org). Workers with a bachelor's degree had median weekly earnings of $1,305 in 2020, compared with $781 for workers with a high school diploma. And the unemployment rate for bachelor's-level workers was 5.5 percent, compared with 9.0 percent for those whose highest level of education was a high school diploma. ("Education Pays") Student loans no longer are a viable option for those who want an education, and for those that get them they become financially devastating. For many it seems that they will never stop paying them in their lifetime.
Studies show that the inverse relation between mental illness and wealth does not show the full story, suggesting that the degree a worker is exploited plays a large role in mental health. Multiple studies including Seth J. Prins' on exploitation and mental illness found that supervisors were more likely (2.33 times more in this particular study) to experience lifetime Anxiety than workers, managers were 1.36 times more likely and owners were only .45 times as likely. Multiple variables were at play in the designations of class, but the study offered a new insight into contradictory class locations that embody aspects of ownership and labor simultaneously. Research using the National Longitudinal Surveys studied the effect of powerlessness in the labour market on mental distress, finding that it "exacerbates the effect of job and economic related stressful life events on psycho-physiological distress and prospectively predicts greater activity limits, psychosocial symptoms, and deteriorating health conditions" (Prins, 4). In the case of supervisors and really all but the highest level management, it was discussed that their role was to enforce policies they had little to no say in, while also having to internalize failure as a personal fault whereas workers are able to externalize failure to the same supervisors or other various factors. Nonetheless, the findings showcase there is more at play in the relationship between labor and mental illness.
Workers are finding themselves unfulfilled and lacking control in their lives, worsening cases of mental illness and substance abuse. As Linda Page puts it:
Because capitalism separates workers from any control over the process of production, the experience of work is highly fragmenting. To achieve maximum productivity, employers expect workers to give maximum effort to the job at hand, to function as laboring machines, not as creative human beings... Consequently, workers are expected to disconnect their awareness from every part of themselves that is not immediately required for the job.. In psychological terms, this is called depersonalization and, as such, is a symptom of traumatic stress" (46).
Substance use rates continue to increase for youth and adults, and have been even prior to the pandemic. 7.74% of U.S. adults and 4.08% of youth had a substance use disorder in 2020. Substance use increased 0.07% for adults and 0.25% for youth since 2019. ("State of Mental Health in America"). When people find themselves detached from their labor and subject to the decisions of others, they often turn to substances that numb them, excite them, or give them some sense of control over their own lives again. "In the mid-twentieth century, there was a lot of research that looked at feelings of powerlessness and alienation on the job. It was often operationalized more specifically as imbalances between the demands of the job and the amount of control that you have on the job. All of those things are shown to be associated with increased mental illness and increased substance abuse." ("New Research Confirms It"). The negative stigma surrounding addiction only worsens the condition, as help is not only hard to find, but hard to accept as it means failure to many.
The stigma surrounding mental health is a direct result of hyper individualism and economic competition. Struggling people are often seen as undeserving of care, which leads to policies that take away their support system; substance abuse in particular is punished rather than rehabilitated. James Gilligan compares the prison system and the prison mental hospital to the sewer system of modern society where "damaged" people are dumped and treated like society's garbage (Page, 43). An independent reporter posted a video to YouTube interviewing multiple homeless veterans living in tents in front of a veterans campus, in veterans park, meant to house these same homeless vets, that turns away those who don't follow their rules: a strict curfew and a ban on any drugs and alcohol. The vets rely instead on strangers' donations and each other. (Glink, 10:06). "When exposed to biomedical explanations for depression, people are more likely to attribute causality to stable and internal processes, rather than as a result of social and environmental conditions" (Cosgrove, 8). Biological psychiatry, as mentioned previously, focuses fault on the individual in regards to mental illness rather than external conditions. In doing so, it solidifies this stigma that mentally ill people simply "don't want to work" as we've seen recently as companies are struggling to find employees and blaming it on would-be applicants rather than work conditions.
Loneliness is one of the leading causes of depression, particularly in the wake of the Covid-19 pandemic, and wouldn't be as debilitating in a society focused on the success of the larger community rather than the competitive, individual nature of capitalism."Strong social ties and community are beneficial for mental health and mental disorders are more common among people with fewer friends and weaker community engagement... loneliness has been described as an epidemic due to dramatic increases in perceived loneliness since 1980" (Zeira, 5). Consumerism and the commodification of our own selves has led to detachment and a lack of empathy in many individuals. School shootings have been on a continuous rise, despite access to guns being limited in recent years. "When a person's self worth is determined by material factors, which are out of their control, their self-esteem is vulnerable to fluctuations... Consumerism is closely tied to status competition and when there is a greater emphasis on social status due to income inequality, extrinsic values are more important for increasing social status. Putting high values on status and constantly competing and comparing oneself to others is exhausting and does not provide what humans need for fulfillment" (Zeira, 6). With work conditions becoming increasingly worse, the gig economy and freelance work has become more popular for workers who want to be employed by themselves instead of someone else. This has led to the commodification of themselves."When workers exert no collective control over production, they can relate only as consumers of the products that other workers produce." (Page, 48) When the worker becomes the product itself, in the highly competitive nature of Capitalism as it already stands, the workers become even further divided.
Biological psychology has been forced into the framework of mental healthcare in the United States, crafting a stigma around the mentally ill and attempting to label them by symptoms. As a result, the systemic issues are blamed on the individual, and working class people remain isolated from one another, their work, and their own selves. While providing access to free healthcare would do a great deal for the state of mental health, it alone will not solve the mental health crisis. Psychotherapists and Psychiatrists alike will only be able to patch up the wounded until more permanent solutions fix the actual conditions and the culture that divides us.
Works Cited
An interview with Seth J. Prins, et al. "New Research Confirms It: Exploitation Makes People Miserable Mentally." Jacobin
"Average Sales Price of Houses Sold for the United States."
"Average Cost of College [2021]: Yearly Tuition + Expenses." Education Data Initiative
Bureau, US Census. "Income and Poverty in the United States: 2020."
Cosgrove, Lisa, et al. "Psychology and Surveillance Capitalism: The Risk of Pushing Mental Health Apps During the COVID-19 Pandemic." Journal of Humanistic Psychology
"Education Pays, 2020 : Career Outlook." U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics
GlinkLegend. "The Dark Reality of Los Angeles." YouTube,
Kassens, - Alice Louise, et al. "Mental Health Crisis during the COVID-19 Pandemic." The Century Foundation
"The State of Mental Health in America." Mental Health America
Page, Linda J. "The Crisis in Mental Health Theory." International Journal of Mental Health, vol. 27, no. 1, Taylor & Francis, Ltd.
Prins, Seth J, et al. "Anxious? Depressed? You Might Be Suffering from Capitalism: Contradictory Class Locations and the Prevalence of Depression and Anxiety in the USA." Sociology of Health & Illness, U.S. National Library of Medicine
U'Ren, Richard. "Psychiatry and Capitalism." The Journal of Mind and Behavior, vol. 18, no. 1, Institute of Mind and Behavior, Inc.
Zeira, Anna. "Mental Health Challenges Related to Neoliberal Capitalism in the United States." Community Mental Health Journal, Springer US
This is my first draft so I know it's pretty rough but I definitely feel like I'm stuck in a thought loop, let me know where I can improve?