Thursday, 20 March 2014

Mental Illness in the Society of Control

Figures announced in August of last year revealed that, in many (Northern) towns in England in any given month, one adult in every six is prescribed antidepressants. If it does nothing else, this statistic once again raises questions about the significance of the word 'mental' in the designation 'mental illness.' The word 'illness,' we can understand; it places conditions like depression on a par with conditions like heart disease and cancer. But 'mental'? What can that mean? Of the mind, presumably, but what is the significance of that? Isn't the mind physical too? This is a big question, of course, but, since the default reaction these days is to treat the mind as if it is purely physical - antidepressants alter the chemical balance of the brain - we can at least conclude that medical orthodoxy, ordinary behaviour and government policy all agree that 'mind' illnesses are no different from 'heart' illnesses or 'stomach' illnesses. The question remains, then, as to what is implied by the catch-all qualifier 'mental' that isolates a certain range of conditions as somehow distinguishable from physical/purely physical conditions?

What is implied is this: that conditions like depression, while being a matter of physical imbalance, are also - in ways that are poorly defined and rarely explicit - a matter of personal responsibility in some way. We are made to own these conditions in a manner that we are never made to own conditions like heart disease (despite the fact that heart disease is often the result of lifestyle choices, a fact of which almost nobody can now be unaware). The various psycho-therapies, relatively rarely sponsored by the NHS, are premised upon this, with their reliance on a long-drawn out testimony on the part of the patient and a tendency to locate the origins of the 'mental' illness in an event/events construed as utterly determining. Your 'mental' illness is yours, and was always destined to  be yours, in a manner that 'physical' illnesses rarely are. A vaguely articulated atmosphere of personal responsibility, and therefore of guilt, pervades the very concept of 'mental' illness, an atmosphere that belies the rhetoric of 'understanding' that surrounds our society's ever-increasing doling out of pills to help alter certain psychological experiences.

The fact that Cognitive Behaviour Therapy has become the NHS therapy of choice is, in this context, telling - a therapy whose commitment to altering ways of thinking and therefore of behaving emphasizes the importance of norms and function. CBT is premised upon there being standards of behaviour which it is undesirable to fall short of, and upon the absolute value of fitting in and putting the next foot forward. A therapy, then, that combines the controlling effects of guilt-dissemination and normalization - a realization of Foucault's claim that 'mental' illness occurs half-way between medicine and morality as a significantly ambiguous and sinister mix of innocent determinism and culpable freedom. You can't do anything about your depression - hence the horrifying numbers that agree to the pills - yet you are also guilty, of its causes and its effects. That this guilt is now as pervasive as it is poorly defined no doubt explains the relative increase in pill-prescription and decrease in therapy provision - the term 'mental' nowadays more or less does the trick on its own. No more costly apparatus is needed to continue to make us feel as if we are the ones who are 'down.'  

No comments:

Post a Comment