Iain Ferguson, Politics of the Mind: Marxism and Mental Distress, Bookmarks, 2017, £9.99, 9781910885659

Reviewed by Susan Clark

The book is a study of the causal link between capitalism and the high levels of mental illness and distress in society today. Indeed, this is the central argument of the book. The author provides worrying statistics. The World Health Organisation states that depression affects 350 m people around the world and further evidence shows that mental illness is inextricably linked to poverty, affecting in greater numbers the unemployed or low paid. Workers are put under considerable pressure to produce more. Stagnant wages, precarious work and rising living costs result in poverty, indebtedness and alienation. Combined with a lack of effective union resistance and collective action, this has resulted in an epidemic of work-related stress responsible for 45% of absences from work in 2015/16. It’s interesting that while the number of working days lost to strike action has gone down, the number of days lost to stress-related illness has risen exponentially. Social care and welfare benefits have been savagely cut in the name of austerity. The unemployed are threatened with a brutal sanctions regime if they fail to find work. The disabled are forced to undergo work capability assessments that aren’t fit for purpose and usually result in their benefits being stopped, inevitably leading to mental ill health.

Ferguson is, therefore, correct in his assertion that the crisis in mental health has become one of the key issues of the twenty first century and that it has two aspects: the extent of mental illness and the nature and availability of mental health services to deal with it. He addresses this by providing a detailed account of Marx’s materialist perspective on mental health. Marx recognized that humans have basic material needs that must be met to maintain our physical and mental wellbeing and survival. Unlike other animals, we have a conscious ability to control our own labour which should provide us with a sense of freedom. However, the main drive in a capitalist society is to increase production and accumulate wealth, not meet social need, and this leads to widespread alienation and mental distress. He knew that to understand those feelings we must look at the social and economic circumstances, reject biological determinism and instead look at how people react to their life experiences.

The author provides historical context by exploring and critiquing the dominant models used to assess and treat mental illness, beginning from religious explanations that ‘madness’ was a punishment meted out by the gods or due to demon possession, through to the dominant biomedical model that holds organic causes such as chemical imbalances responsible for mental illness. The solution is often seen as medication and Ferguson draws our attention to the link between the over-prescription of anti-depressants and the financial relationship between the psychiatry profession and pharmaceutical industry. Psychiatry has a gruesome history and the use of barbaric treatments such as ECT, insulin induced comas and lobotomies is explored. A detailed account and critique is also provided of Freud’s radical ideas on sexual repression and the use of psychoanalysis.

The author points out that attitudes to mental health change during periods of social upheaval such as in the 1960s with the development of the anti-psychiatry movement. The most famous proponent of this was the controversial psychiatrist, RD Laing, who rejected the determinism of the biomedical model and sought to understand the meaning behind mental distress by linking it directly to life experiences.

The use of asylums and institutionalization reduced over time as ‘community care’ became the buzzword in managing mental illness. The stigma attached to mental illness reduced and the author discusses the resultant growth of the mental health movement from the 1970s onwards. This involved service users, radical social work and professionals campaigning to give the mentally ill a voice by demanding better treatment and services.

In conclusion, living under capitalism is responsible for mental distress. Mental illness is not solely down to the individual, either through some physical cause or lack of moral fortitude; it has political and social causes. It is the result of the capitalist obsession with the accumulation of wealth at the expense of meeting the basic social and emotional needs of a society. The resultant inequality, oppression and alienation lead to feelings of powerlessness and, ultimately, mental distress. Rather than treating the individual to be able to live in an unliveable world, our response should be to fight to change society for the better through collective action.

As we see a renewed interest in socialist politics, the author has chosen the right time to produce a comprehensive study on the Marxist/socialist debates surrounding mental distress. Its sources include mental health service users, as well as leading names in psychiatry including Freud, Laing and Sedgewick. The book is detailed but the information and debates are presented in a clear and accessible way. You can tell that Ferguson is very passionate about the subject, showing great compassion and solidarity with those living with mental distress and those working to treat them.

Susan Clark is a Socialist Workers’ Party (SWP) member in Glasgow and a third sector worker.