Limbus 16 May 2015

You can download the Powerpoint slides accompanying my Limbus talk here:

Limbus talk Powerpoint presentation, Totnes May 16th PP

 While this notice is here, I am still working on making these notes clearer, fuller and referenced to a useful bibliography. Contact me by email for references or clarification of anything in the notes:

paulwilliamatkinson@gmail.com

 

1. Introduction

I want to talk politics, not usually very popular among psychotherapists,  I know. But from my point of view at least, if ever there was a time for us to talk politics, this is it.

I am going to use the word “capitalism”. If the term neoliberalism has any meaning at all, it is as a particular era or development of capitalism – ie to be simple, its agenda is the redistribution and accumulation of capital (frozen desire)  – wealth and power – for a very small social and political elite – at the expense of the majority.

I see neoliberalism as a complex, often contradictory set of trends. Not a concerted conspiracy rather over time, an identifiable direction of travel, which 40 years after the first articulations of political change can now be identified and articulated. However, there are also conspiracies, planning

Want to suggest that like it or not psychotherapy has been a player in NL society. As always, many developments and changes have been as much for the good as anything more destructive. Marx right on dialectical process. Situationists also right on recuperation.

One amazing quality of neoliberalism is the success of the assertion that there is no alternative…TINA (slide 2)  Still alive today. Austerity… and Newsnight threat to ban the word, along with “privatisation”.

[BBC losing the license fee?]

I want to look at the socio-economic trends. What does neoliberealism mean for people’s lives, especially the lower percentiles of income and wealth. The direction of flow has to stop. We have to play our part in stopping it. There is plenty of resistance, and no doubt we will be ok in the end. But we know that people do have to do something.

2. Two Definitions/Visions of Neoliberalism

Who uses the term neoliberalism?????

Definition 1 From David Harvey’s Intro    2 slides – 3 & 4

1. Human well-being is optimally served by the free individual expressing his/her desire in a free market of monetised transactions. The individual operating in the medium of the free, competitive market is the only reliable source of values  – not only of economic well-being but of the common good, social values  and the ethics of human relating generally .

2. While there will always be a minority that cannot compete/operate in the market, on the whole social security should be confined to a minimum safety net….  failure to prosper should be understood as an individual failure to adapt and complete  in the free market , people can be incentivised or trained to do better, especially to WORK.

3. The role of the state is to create and preserve an institutional framework appropriate to free market activity. It has to guarantee the quality and integrity of money. It must set up those military, defence, police, and legal structures and functions required to secure private property rights and to guarantee, by force if need be, the proper functioning of markets.

4. If free markets do not exist (in areas such as land, water, education, a unionised labour, environmental pollution, health care, social security, psychological well-being, and information governance, personal life-style choices) then they must be created, by state action if necessary. But beyond these tasks the state should not venture. The state is too biased, bureaucratic, slow, lobbyists.

Hayek’s influence. Road to Serfdom  1940-43   slide 5

Milton Friedman quotes and his influence on Thatcher:  slides 6 to 10

“Society doesn’t have values. People have values.”

“The society that puts equality before freedom will end up with neither. The society that puts freedom before equality will end up with a great measure of both”.

From Created Equal, an episode of the PBS Free to Choose television series (1980)

Mrs T: “They’re casting their problem on society. And, you know, there is no such thing as society. 

There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first. It’s our duty to look after ourselves and then, also to look after our neighbour.”

Interview 23 September 1987, as quoted in by Douglas Keay, Woman’s Own, 31 October 1987, pp. 8–10.

Definition 2     A second brief, and rather abstract, definition of neoliberalism might be:

but very relevant to the internet, social media phase of neoliberalism::

• firstly, the privatisation, monetisation and marketisation of as many economic and social transactions as possible
• the desire to intensify and expand the market, by increasing the number, frequency, velocity, repeatability, and formalisation of transactions
• the financialisation of these transactions as far as possible

• Slide 11  The ultimate (unreachable) goal of neoliberalism is a universe where every action of every being is a market transaction, conducted in competition with every other being and influencing every other transaction, with transactions occurring in an infinitely short time, and repeated at an infinitely fast rate. It is no surprise that extreme forms of neoliberalism, and especially cyberliberalism, overlap with semi-religious beliefs in the interconnectedness of the cosmos.

Treanor’s definition expresses an aspect of the post-modern – velocity and financialisation.

http://web.inter.nl.net/users/Paul.Treanor/neoliberalism.html

3.  A current political dilemma for psychotherapists and counsellors

Some interest among psychotherapists in neoliberalism

Perversion, neoliberalism and therapy:  The audit culture in mental health services

Rosemary RizqPsychoanalysis, Culture & Society 19, 209-218 (June 2014)

slide 12 Paul Verhaeghe  What about me?

Big literature on the cultural aspects of neoliberalism – and on subjectivity:

Atomisation

Fear (debt and the precariat)

Mass individualism and velocity Paul Virilio etc

I want to keep us focused on basics  – where material conditions of neoliberal society meet psychotherapy perspectives.

What kind of players do we want to be? So to do that want to offer a very current development which I think raises a lot of the fundamental questions about what kind of players in the world of political economy we therapists are.

slide 13  Back in July 2014, the Daily Telegraph published an article:

Tories discuss stripping benefits claimants who refuse treatment for depression

Senior ministers believe the rules should be reviewed in order to reduce the “huge” numbers of people who are declared unfit for work due to mental health problems

At that time, I and a colleague contacted UKCP.  Only BPC responded properly – http://www.bpc.org.uk/news/it-highly-unethical-force-people-have-treatment

We talk to UKCP … nothing Norman Lamb reassures – issues drops out of picture.

In the Budget statement this year, the idea reappears – apparently without coercion: slide 14

 “Starting from early 2016, the government will provide online Cognitive Behavioural Therapy (CBT) to 40,000 Employment and Support Allowance and Jobseeker’s Allowance claimants and individuals being supported by Fit for Work. From summer 2015, the government will also begin to co-locate Improving Access to Psychological Therapies (IAPT) therapists in over 350 Jobcentres, to provide integrated employment and mental health support to claimants with common mental health conditions.”

slide 15 Conservative manifesto page 28

slide 16 And at the beginning of May – coercion in the form of SANCTIONS become explicit

BENEFITS AND POVERTY JOHN PRING ON MAY 1, 2015

The Tory minister, Mark Harper,  for disabled people appears to have accidentally admitted what many disabled activists feared: that a Conservative government would cut the out-of-work benefits of people with mental health conditions if they refused treatment.

In a debate broadcast on local radio, Mark Harper strongly suggested that people with mental health problems would be among the group with “long-term yet treatable” conditions who could be sanctioned if they refused treatment.

http://www.disabilitynewsservice.com/election-2015-harper-suggests-backing-for-mental-health-treatment-sanctions/

3a. Get to work therapy

The linking up of psychological therapies, disability and sickness benefits and “mental health problems” has a long history by now.

Being depressed or anxious, in need of psychological therapy and on benefits was the main theme of Lord Layard’s Depression Report of 2006.

We now have a million people on Incapacity Benefits because of mental illness – more than the total number of unemployed people receiving unemployment benefits. 

At one time unemployment was our biggest social problem, but we have done a lot to reduce it. So mental illness is now the biggest problem, and we know what to do about it. It is time to use that knowledge.

In the 2012 IAPT report 3 year report (“first million patients”) :

As this report indicates, at the end of the first three full financial years of operation (end of March 2012), more than 1 million people have used the new services, recovery rates are in excess of 45% and 45,000 people have moved off benefits. 

The linking of therapy and work through IAPT has been problematic enough. 

But the problem with linking out-of-work benefits with psy therapy is that the political campaign by successive governments to reduce the numbers on benefits – particularly long-term benefits like incapacity benefits – is at one of the most violent cutting edges of neoliberal capitalism.

3b. Work Capabilty Assessment  and Atos

In 1995, assessing a person’s eligibility for Incapacity Benefits was taken out of the hands of GP’s.

This was tightened up by Labour under the Welfare Reform Act (2007) and renamed

The WORK CAPACITY ASSESSMENT.    In 2008, Labour outsourced WCA to ATOS a private IT firm (French/Dutch), using the name ATOS Healthcare.  Assessment criteria were tightened again in 2011 by IDS’s DWP, expanded the scope of the programme to reassess the 2.5 million people the DWP had previously judged to be entitled to Incapacity Benefit.

slide 17 Daily Mail  Oct 2010]

UNUM Yet, a manipulated version of the Engel BPS (biopsychosocial) assessment model, emphasising the possible psychological factors of disability and disregarding the biomedical factors, is used by Unum Provident Insurance and by the DWP as a method of removing as many chronically sick and disabled people as possible from funding, or preventing access to it.

Unum Provident Insurance were fined $31.7 million in 2003 in a class action law suit in California for running ‘disability denial factories’  and $15 million in 2005 by the California Department of Insurance Commissioner, John Garamendi, who stated that ‘Unum Provident is an outlaw company.

3c. Sanctions

In January 2015, the Methodist Church gathered evidence though DWP FOI’s that “more than 100 people per day with mental health problems are having their benefits sanctioned”.

If you are on Employment and Support Allowance with mental health problems, you are far more likely to be sanctioned than if you are physically disabled.

[2 slides on Mental Health sanctions  – slides 18 and 19]

18 = that 50% of claimants are MH   BUT  62% of sanctions are MH

19 = No of sanctions by sub-categories of Employment and Support Allowance (disability) Look at the lift-off

As a result, the press has been littered with apalling reports of profound irrationality, punitive treatment of claimants, horrible cruelty, gross deprivation, and many deaths.

slide 20 Atos kills

There was Mark Wood, a 44-year-old man with complex mental health issues who starved to death after he was passed as fit-to-work by an Atos assessment. Wood, who had his sickness and housing benefits stopped and was forced to live off just £40 a week, was found weighing just 5st 8lbs and with a body mass index that his doctor said was not compatible with life.

Alliance Letter family: son committed suicide…….

David Clapson 59, who had diabetes, died in his flat in Stevenage on 20 July 2013, from diabetic ketoacidosis [keeto-acid-osis](caused by an acute lack of insulin). his younger sister, discovered his body, she found his electricity had been cut off (meaning that the fridge where he kept his insulin was no longer working). There was very little left to eat in the flat – six tea bags, an out-of-date tin of sardines and a can of tomato soup. His pay-as-you-go mobile phone had just 5p credit left on it and he had only £3.44 in his bank account. The autopsy notes reveal that his stomach was empty.

But officials at the Jobcentre believed he was not taking his search for work seriously enough, and early last July, they sanctioned him – cutting off his benefit payments entirely, as a punishment for his failure to attend two appointments.

Death watch counts : The Black Triangle Campaign has listed 70 people dead in connection with Work Capablilty Assessments and Sanctions upto October 2014.

And http://calumslist.org

Other aspects of sanctions

Report on food bank use  March 2015

Overall, it found problems with social security benefit payments accounted for nearly half (47%) of referrals. The bulk of these problems related to administrative delays, benefit sanctions and incapacity benefit stoppages.

slide  21

Jobcentre bosses set up “hit squads” to target benefit claimants for sanctions and put pressure on them to sign off the dole, according to evidence presented to an inquiry by MPs. Longden’s evidence covers events he says he witnessed at Salford and Rochdale jobcentres between 2011 and 2013. It has been lodged with the Commons work and pensions select committee, which is investigating benefit sanctions policy. reported March 2015…wants bigger investigation. EHRights judgment..

Staff who failed to meet sanctions targets each month were threatened with disciplinary action, he claims.

slide 22 on ridiculous reasons for sanctions]

Guy sanctioned because he stayed on newborn in Intensive Care.

And slide 23 on Tower Hamlets  ‘Foodbank plus’ (New Statesman March 2015)

3d. Atos, DPAC, Maximus, Fit for Work

The idea then that IAPT therapists might be put into  350 Jobcentres is alarming, what is the role of the therapists going to be within the culture of maximising sanctions and getting claimants off benefits.

Are we to believe that therapists will not be instructed to set up their own coercive targets, including sanctions for refusing therapy, being late for a sessions, DNA’ing. Therapy by coercion must surely be UNETHICAL. But will the profession do anything about it.

This spring, ATOS has withdrawn from WCA’s in disgrace.

Government has employed another firm – MAXIMUS – to take over. US firm. For the fiscal year ending September 30, 2013, Maximus, Inc. took in revenues of $1.33 billion and reported profits of $116 million.^[3] It is publicly traded on the New York Stock Exchange.

slide 24 on Atos>Maximus Guardian piece]

In 2000, an audit showed Maximus had billed the state of Wisconsin almost $500,000 since 1997 in improper or questionable expenses; the company paid back $500,000 and made another payment of $500,000 as a show of good faith. 

DPAC and other disability and benefits claimants orgs have already been protesting. Maximus using same staff, and methods

5 slides   25 to 29

But there is more:

There is also a national programme of similar provision of therapy for employees being rolled out across the country called – Fit for Work.

Fit for Work has been outsourced to a private company called Health Management Limited, which is subsidiary of Maximus.

slide 30 of roll out of FfWork

Mention Alliance letter here….  slide 31  450 signatories

SO this is the toxicity

 

4. Creating Mental illness  

Since the 1980’s the developed world seems to have witnessed a massive epidemic of mental ill-health.

For Layard and Clark, untreated depression and anxiety is the major source of unhappiness in this country. Among benefit claimants, the major source of disability is mental illness.

If we look at the issue of enforced therapy for benefits claimants with mental health diagnoses as an isolated issue, I hope most of us would want to campaign to outlaw such an unethical use of our profession. Use of psychiatry in Soviet Union. Psychologists advising on the torture of rendered ‘terrorist suspects’.

But something much broader and deeper is at stake – the creation and capture of subjectivity as “Mental Ill-Health” under neoliberal capitalism.

What does the epidemic growth Mental Illness mean?

What does it mean when:

• the MH Foundation declares that “about a quarter of the population will experience some kind of mental health problem in the course of a year, with mixed anxiety and depression the most common mental disorder in Britain.

http://www.mentalhealth.org.uk/help-information/mental-health-statistics/

• slide 32 & 33  Layard’s Depression report says:

“According to the respected Psychiatric Morbidity Survey (2007), one in six of us would be diagnosed as having depression or chronic anxiety disorder, which means that one family in three is affected”.

http://cep.lse.ac.uk/pubs/download/special/depressionreport.pdf

• slide 34    2008 WHO report: in rich countries, when you allow for severity, 40% of all illness is mental illness. 2010 report world DALYS (Disability Adjusted Life Years down to MH)

The DALY is a health gap measure, which combines information on the impact of premature death and of disability and other non- fatal health outcomes. One DALY

can be thought of as one lost year of ‘healthy’ life, and the burden of disease as a measurement of the gap between current health status and an ideal situation where every- one lives into old age free of disease and disability.

http://www.who.int/whr/2001/en/whr01_ch2_en.pdf?ua=1

• Between 1938 and 1955 several reports indicated that the prevalence of depression in the general population of UK was below 50,000  or under 1%. In the 1960s and ‘70s, the beginning of the  reveals that even the lowest figures in the psychopharmacological era are 7 to 10 times this.

 http://inhn.org/fileadmin/previews_new/From_Melancholia_to_Depression_March_6_2014.pdf

• slide 35  MH problems of 15-16 year olds doubled 1974-1999 in the States

Layard and Clark “Thrive”

• slide 36 By the late 1990’s 1.8m UK adults were taking anti-depressants. By 2014 this increased to 4m. According to official NHS data, more than 53 million prescriptions were handed out for drugs such as Prozac and Seroxat in England last year – a record high, and a rise of 24.6 per cent since 2010.

http://www.telegraph.co.uk/news/nhs/10775085/Record-numbers-on-happy-pills.html

• slide 37  Quick survey of mentions of depression, MH etc in Daily Mail and Telegraph

 

4a. Big Pharma and MH

As far as Big Pharma is concerned, many commentators agree that categories of mental illness have been to some extent created and defined by the drug companies.

See eg Mad in America, Critical Psychiatry, Asylum etc.

http://www.madinamerica.com

http://www.criticalpsychiatry.co.uk

http://www.asylumonline.net

So: 2004 Boston Post article on David Healey’s work Talking back to Prozac –

David Healy was among the first psychiatrists to prescribe Prozac. Now he’s one of the fiercest critics of Big Pharma’s “marketing” of depression. Did his outspoken views cost him his job?

By Joshua Kendall

One of Healy’s main arguments is that the drug industry has played a much greater role in shaping our understanding of psychiatric illness than has previously been acknowledged. In other words, Healy argues, first come the pills and then the disease.

Back in the 1950s and ’60s, anxiety was the illness du jour, and tranquilizers like Valium the prescribed treatment. Depression was just a blip on the radar screen, presumed to affect perhaps one in 10,000 in the general population, and typically treated with hospitalization and perhaps electroshock therapy.”

Indeed the idea that there might be a depression that drugs could treat had in one sense to be invented as had the idea of an antidepressant,” writes Healy in “The Antidepressant Era.” The first generation of antidepressants hit pharmacy shelves around 1960. Without much of a market, they were by and large a commercial flop. They also had many troubling side effects.

When fluoxetine, or Prozac, was discovered in the mid-1970s, Lilly was thinking of marketing it as an anti-anxiety agent. But the crash of Valium-mania in the late ’70s changed all that. Suddenly, Valium went from “magic bullet” to dangerous and addictive substance. So, when Eli Lilly rolled out Prozac, the first of the SSRIs, in 1988, the company decided to market it as a safer alternative to the older antidepressants that could also be prescribed by primary care doctors, not just specialists.

Today it is commonly said that as many as 20 percent of Americans suffer from depression at some point in their lives. But Healy rejects the conventional wisdom that this startling increase over the last 50 years is due largely to improved diagnosis and reduced social stigma. 

In Healy’s eyes, most of the patients diagnosed with mild or moderate depression would be better characterized as suffering from “community nervousness.” Though Healy sees this condition as a real biological disorder, he emphasizes that it “could be due to a host of different factors such as overwork, stress, and constitutional deficits. But clinicians everywhere are diagnosing depression because that’s what they have a treatment for,” he says.

Big Ph and RCT’s

The medicalization of “ups and downs”: The marketing of the new bipolar disorder

Joanna Moncrieff j.moncrieff@ucl.ac.uk

University College London

Abstract

The concept of bipolar disorder has undergone a transformation over the last two decades. Once considered a rare and serious mental disorder, bipolar disorder is being diagnosed with increasing frequency in Europe and North America, and is suggested to replace many other diagnoses. The current article shows how the modern concept of bipolar disorder has been created in the course of efforts to market new antipsychotics and other drugs for bipolar disorder, to enable these drugs to migrate out of the arena of serious mental disorder and into the more profitable realm of everyday emotional problems. A new and flexible notion of the condition has been created that bears little resemblance to the classical condition, and that can easily be applied to ordinary variations in temperament. The assertion that bipolar disorder is a brain disease arising from a biochemical imbalance helps justify this expansion by portraying drug treatment as targeted and specific, and by diverting attention from the adverse effects and mind-altering properties of the drugs themselves. Childhood behavioural problems have also been metamorphosed into “paediatric bipolar disorder,” under the leadership of academic psychiatry, with the assistance of drug company financing. The expansion of bipolar disorder, like depression before it, medicalises personal and social difficulties, and profoundly affects the way people in Western nations conceive of what it means to be human.

Moncrieff, J. (2014) The medicalization of ‘ups and downs:’ the marketing of the new bipolar disorder epub ahead of print, April 7th 2014

UK figures for growth in anti-depressants prescriptions slide 38

Profits of pharma companies  slide 39

recent Guardian stories around depression etc

 

4b. Psychotherapy as enclosure

Many of us psychotherapists resist the notion of Mental Health. Mental health, as we know, is a contested concept among psychotherapists.. It implies a medical model of psychological life – healthy or unhealthy, diagnosable and treatable, open for evidence-based techniques in the hands of trained professional experts.

Many of us have resisted the  regulation of P&C under the rubric of health care profession precisely because we do not identify our work as health care for the mentally ill.

Our languages are maybe to do with internal conflict, trauma, emotional disturbance and containment, individuation, self-actualisation, relational containment etc

But what “illnesses of the mind (MH)” and “disturbances of psyche (psychotherapy)” have in common is the focus on the individual as someone separable from society. We attend to the subjectivity of a person’s lived experience as an inner world experience. We work with the mind or the psyche of the individual. On the whole, we separate our clients’ psychological worlds from the socio-economic. We deal with psyche as something separate from the lived world  – Husserl’s Lebenwelt.

Psychotherapy and counselling along with psychiatry and clinical psychology – their languages of psychological theory, psychopathology and diagnoses, clinical techniques and their claims to scientific and statistical evidence – has been part a capture or enclosure, of psychological life for over a century.

Talk about the psycommons and enclosure HERE

slides 40-41  If we think of psychopathology and diagnostic labels, for example, take a look at some the reports that came out of the early Freudian polyclinics set up after WWI in Vienna, Berlin, London (E.A. Danto’s work). Here’s a table of the results from the  y Max Eitingon

 

Eitingon, M. (1923). Report of the Berlin Psycho-Analytical Policlinic1. Bul. Int. Psychoanal. Assn., 4:254-269

They read like an early DSM.

Freud’s theory of instinctual drives, the Oedipus complex, infant sexuality, hysteria etc., transference

Klein’s paranoid/schizoid and depressive positions, introjection and projective identification

Jung’s archetypal uncs, psychological types, anima and animus, shadow etc

One person psychologies –

Bion’s psychoan O, basic assumptions, nameless dread.

Humanistic notions of self-actualisation, unconditional positive regard, scripts, internal dialogues, sub-personalities.

Cognitive behavioural therapy’s socratic questioning, internal dialogue, automatic thoughts, negative thinking, core  beliefs

Freud and early advertising slides 42-43

http://www.theguardian.com/education/2002/mar/10/medicalscience.highereducation

and   in Wikipedia:  “To expand the number of women smokers Hill decided to hire Edward Bernays, who today is known as the father of public relations, to help him recruit women smokers. Bernays decided to attempt to eliminate the social taboo of women smoking in public. He gained advice from psychoanalyst A. A. Brill stated that it was normal for women to smoke because of oral fixation and said, “Today the emancipation of women has suppressed many of their feminine desires. More women now do the same work as men do. Many women bear no children; those who do bear have fewer children. Feminine traits are masked. Cigarettes, which are equated with men, become torches of freedom.”^[4] In 1929 Bernays decided to pay women to smoke their “torches of freedom” as they walked in the Easter Sunday Parade in New York

See also:

http://www.apa.org/monitor/2009/12/consumer.aspx

and

http://www.academia.edu/2428249/Consumerism_and_Identity_Some_Psychoanalytic_Considerations

and

https://www.psychologytoday.com/blog/meaningful-you/201305/psychoanalysis-in-the-age-just-do-it

http://www.peterharrington.co.uk/blog/the-birth-of-mad-men-ernest-dichter-psychoanalysis-and-consumerism/

http://libcom.org/library/psychoanalysis-freud-civilization-capitalism

and https://vimeo.com/85948693

http://www.theguardian.com/education/2002/mar/10/medicalscience.highereducation

Jason and addiction

Adam Curtis – Century of the Self

Something similar has been happening in psychotherapy provision. Growth of psychotherapy in the 70’s:

• my history of growth movement at the Open Centre, etc on to the Guild of Psychotherapists, number of radical psychoanalytic organisations starting up in the 70’s..
• what are the numbers of therapists/counsellors
• CBT growth  : So, from Thrive: 3 slides – 44,45,46

Until the 1950s there were no scientifically validated treatments for most mental health problems. But then came striking drug discoveries, and in the following decades major advances in psychological therapy. These advances were made by using the same standard methods of scientific experiment as are used in treating physical illnesses. As a result we now have a range of treatments for mental health problems which have high success rates – as high as the success rates in treating many physical problems.

In 1977, Beck and colleagues published the first randomized controlled trial of cognitive therapy for depression. The results stunned the psychiatric world. Cognitive therapy was significantly more effective than treatment with the leading anti-depressant.

Since the 1980s dozens of researchers have been inspired by his work and have developed theoretical models of different mental health conditions that highlight the way in which distorted thinking and changes in behaviour combine to maintain the problem

CBT and NeoLiberalism seem very attached to each other – come back to this. positive, entrepreneurial can do individual, velocity

The professionalisation of P & C…….

Psychiatry’s role creating ‘psychologised society’ – DSM5 and its critics.

For instance, mourning (or bereavement) may be considered a mental disorder, according to the new manual. Formerly, it was viewed as a normal reaction to a significant loss in one’s life, unless it was very extended and resulted in obvious symptoms and maladaptive behavior. However, the new edition views intense mourning as a condition that may require psychiatric treatment. Hence, if one reads DSM-5 literally, bereavement can be viewed as pathological.

http://www.huffingtonpost.com/mark-rubinstein/dsm-5_b_3328188.html

Psychotherapy tends to isolate the individual. (Occupy and Psychol against Austerity, piece in Guardian on 13 May on consulting imposed on developing world after disasters/traumas)

http://www.theguardian.com/global-development-professionals-network/2015/feb/05/mental-health-aid-western-talking-cure-harm-good-humanitarian-anthropologist

(Tavi story)

So, how far is “mental illness” a construct of modern capitalist society?

Western individualism……

 

5. Connecting the soci-economic to the psychological

If we have discovered a mental illness epidemic in the UK and elsewhere since the 1970’s/80’s could this possibly mean that neoliberal capitalism is making us ill?

If so, do we not need to be acknowledging that what is being diagnosed and treated as mental illness or psychological ill-being is an aspect or symptom of our society, its political economy, its social and cultural values.

Might not people’s material conditions, for example, be a cause of their psychological and emotional conditions. Might not their psychological life be an inevitable dimension of their lived experience – inseparable from it.

Eric Maisel slide 47

Psychology posits many “theories of motivation.” …..  The mistake is the way that these theories exclude the human experience. We aren’t machines, functioning or not functioning: we are human beings living.

Think of the mother of a young soldier fighting during the second world war.

She is “motivated” in all the textbook ways—she gets to work, she buys lottery tickets, she drinks water, she has sex—but her reality is that she is holding her breath. If you ask her why she is having headaches, stomachaches, sleep problems, an inability to orgasm, and sudden crying fits, she may well say, “I am waiting for my son to come home.” Will we really stand for a psychiatrist answering this with, “I have a pill for you!”? Will we really stand for a psychotherapist exclaiming, “Oedipal issues!”? Absolutely not!

And who isn’t in the middle of calamity? Forget about world wars. What is it like for the quarter million women diagnosed with breast cancer each year and the one in eight women threatened by it? What is it like for a gay youth in a fundamentalist town? What is it like for a workingman or workingwoman living in a tract home in Amarillo, Queens, or Dayton? What is it like for a writer with no publisher, a painter with no gallery, a musician with no gigs? What is it like for an obese man or an obese woman with no sex life? What is it like for the millions who hate their jobs, the millions with no job, the millions who cringe when their mate enters the room, or the millions who have aged into invisibility?

http://dxsummit.org/archives/2032

Slides 48-52 austerity and MH in Britain

There are constant laments about the so-called loss of norms and values in our culture. Yet our norms and values make up an integral and essential part of our identity. So they cannot be lost, only changed. And that is precisely what has happened: a changed economy reflects changed ethics and brings about changed identity. The current economic system is bringing out the worst in us.

http://www.theguardian.com/commentisfree/2014/sep/29/neoliberalism-economic-system-ethics-personality-psychopathicsthic  Paul Verhaeghe

Every psychotherapist knows that their clients are not just bringing their psychological experience into the consulting room. They are brining their lives. Lived experience cannot be divided into the subjective and the objective, the internal and external, the psychological and the socio-economic. Lived experience is holistic, it is everything – in its living relationship with everything.

But do we honour that knowledge in the way we work with people?

In today’s UK, according to Layard and Clark and the evidenced based philosophy of IAPT, apparently not:

Last November, I went to a meeting of Action for Happiness at which Layard and Clark were speaking about their new book Thrive.

The Action for Happiness website offers the following pie-chart graphic of the causes of mental ill-health: slide 53

.

• Genes ….  In their chapter on the causes of mental illness, the authors of Thrive devote the first nine pages to talking about genes.15 There is one page on childhood, and just over one page on job loss, stressful work environments, physical illness and disability. The two pages on social class and income argue that these are not causal factors in the aetiology of psychological ill-health. The section on what makes mental ill-health persist goes back to genes and innate personality.
  The final section, on the nature of society, identifies four factors affecting well- being across a society – the level of corruption, freedom, trust and social support. Financial inequality and poverty are dismissed. Ideologically led policies of social and economic exploitation, the debasement of democratic processes and the exploitation of the majority by a political and financial elite are not discussed, nor are the structures of power in society generally.

• Thriving (being happy) is primarily associated with subjective states of mind, located within the individual, rather than a more realistic and holistic picture of a relationship between internal and external worlds. The obstacles to individual thriving are primarily negative states of mind that the individual can remove or moderate through positive thinking and positive actions. In my view, the social and economic causes of psychological ill- health are consistently underplayed.9

• This downplaying of the social, political and material contexts of subjective states involves side-stepping overwhelming evidence, amassed over decades, that economic and social deprivation is a major cause of psychological ill-health. See, for example:

.  slide 54  The World Health Organization 2014 report on the social determinants of mental health worldwide.10
.  The Institute of Health Equity and Michael Marmot on the impact of the coalition government’s austerity policies in London, published in 2012.11
.  slide 55 The American Psychological Association’s Resolution on Poverty and Socioeconomic Status 2000.12
.  The Royal College of Psychiatrists 2004 paper ‘Poverty, Social Inequality and Mental Health’.13
.  The Mental Health Foundation’s working paper of 2013.14

[11] http://www.instituteofhealthequity.org/projects/social-determinants-of-mental-health/social-determinants-of-mental-health-full-report.pdf

[12] http://www.instituteofhealthequity.org/projects/demographics-finance-and-policy-london-2011-15-effects-on-housing-employment-and-income-and-strategies-to-reduce-health-inequalities/the-impact-of-the-economic-downturn-and-policy-changes-on-health-inequalities-in-london-full-report

[13] http://www.apa.org/about/policy/poverty-resolution.aspx

[14] http://apt.rcpsych.org/content/10/3/216.full

[15] http://www.mentalhealth.org.uk/content/assets/PDF/publications/starting-today-background-paper-3.pdf.

Slide 57  According to Jack Carney’s piece in Mad in America (2012), before the 1980s, academic studies of the relationship between social deprivation and mental illness concluded that the former was the primary cause of the latter. With the rise of neoliberalism, studies have generally concluded the opposite – that mental illness causes social deprivation. Does poverty play a role in causing a person’s mental illness or does a person become ill and simply drift down the socioeconomic ladder into poverty? The implications for neoliberal governmental policy are obvious.

Most recently, Christopher Hudson, in a longitudinal study conducted between 1994 and 2000 in Massachusetts [18], published in 2005 and apparently not widely known or discussed, confirmed the social causation hypothesis. Starting with the indexed acute psychiatric hospitalizations of his 34,000 study subjects, each of whom was a Medicaid recipient and, by definition, poor, he tracked their employment status and place of residence over the course of the study.

Hudson concluded that there was “a remarkably strong and consistent negative correlation between socio-economic conditions and mental illness, one that supports the role of social causation in mental illness and cannot be accounted for by geographic or economic downward mobility …” He closed with the following recommendation: “… continued development of preventive and early intervention strategies of the major mental illnesses that pay particular attention to the devastating impacts of unemployment, economic displacement, and housing dislocation, including homelessness.”

http://www.madinamerica.com/2012/03/poverty-mental-illness-you-cant-have-one-without-the-other

 

6. The socio-economic facts

So, if we come back to neoliberalism and my title

Heart & Soul in the Grip of Neo-Liberalism:

What kind of players do we, psychotherapists, want to be?

Economics are the method; the object is to change the heart and soul  Margaret Thatcher, May, 1981

Growth is not the end in itself. What the end is  –  the neoliberal individual. The individual for whom everything is on the market….

And it is the acceleration, commodification and ultimately financialisation of this separation of mass individualism that is in fact at the heart and soul of neoliberalism.

But behind the rationale of neoliberalism as economic growth from which everyone benefits (trickle down), what we have actually since is a violent redistribution of income and wealth towards the elites of the world – the corporate and political power elite.

The ‘mission’ has been to capture the heart and soul of the nation for exploitation.

slide 58    “The neoliberal road to serfdom”    (parody of Hayek)

If in fact we go back to David Harvey and look at the political economy of this neo-liberal phase of capitalism, it quickly becomes clear that we are living in a mentally ill society – a political economy which perpetrates a terrible violence on the lives of ordinary people  in the name of economic growth and the inevitability of competitive globalisation. For Harvey and many others, the 1970’s saw a relatively concerted political campaign within the right – here and in the States in particular – to abandon Keynesian economics and its commitment to the redistribution of wealth and resources and social welfare in favour of monetarism and the expansion of privatisation and the so-called free market. In reality, we can see the evidence for what he and others argue is the realignment of the economy in favour of capital accumulation – in this era financial capital.

The doctrine of “expansionary austerity” is largely associated with work by Alberto Alesina, an economist at Harvard. Alesina used statistical techniques that supposedly identified all large fiscal policy changes in advanced countries between 1970 and 2007, and claimed to find evidence that spending cuts, in particular, were often “associated with economic expansions rather than recessions”. The reason, he and those who seized on his work suggested, was that spending cuts create confidence, and that the positive effects of this increase in confidence trump the direct negative effects of reduced spending. Krugman Guardian http://www.theguardian.com/business/ng-interactive/2015/apr/29/the-austerity-delusion

So  if we take a look at a few graphic representations of what the neoliber era has meant for the lower income percentiles of our society, I think it is pretty clear that psychological distress is likely to have some connection with socio-economic developments.

It is striking that a number of crucial trends in economic and social policy have reversed since the 1980’s. Picketty slides 59-62

slide 59 Here, based on Thomas Picketty’s work, is the shape of top incomes falling as a % of total incomes from the Great Crash of 1931 to the beginning of the 1980’s, then recovering… – UK.

slide 60 Picketty again comparing % of income of top 0.1% with the bottom 90% in the US

slide 61 rise in % income of the 1% in UK

slide 62 Picketty – the reestablishment of private wealth as a multiple of annual national income

slide 63    top 80 wealthy cf the world

slide 64      correlation bt inequality and MH – The Spirit Level

slide 65  Meanwhile real average wages have been falling since the mid-80’s, giving the lie to the ‘trickle down economy’ theory.

slide 66  According to  ‘Breadline Britain’ poverty in the UK has been growing since the 1980’s

slide 67   Poverty will definitely grow with the Tories in

slide 68  and so has child poverty, with decrease under Labour in the 1990’s, ’00’s now reversing

slide 69  We have the shocking growth of food banks all over the UK

slide 70  Fuel poverty

slide 71   Malnutrition among hospital admissions

As far as work is concerned, growth in low paid, part-time, zero-hour and self-employed work.

The nature of work has been changing too of course.

• http://www.theguardian.com/politics/2013/sep/06/uk-lowest-paid-classed-not-working-enough
• – http://www.theguardian.com/commentisfree/2015/apr/26/tories-low-paid-families-benefit-units-parents-minimum-wage

slide 72   At the moment, the UK has one of the highest % of low – paid work , second only to USA

slide 73  9/13  low paid workers told to work more

slide 74     We have growing rates of part-time and self-employment

slide 75  Much of the latter on the margins of sustainability (better than benefits or zero-hour)

slide 76   Zero-hour contracts have rocketed under the coalition

slide 77   As has personal household debt

slide 78 & 79    Privatisation of housing

slide 80   Privatisation generally [example of Barts PFI?]

slide 81-82   Decline in progressive taxation

So, first,  socio-economic as a source of anxiety and depression.

Loneliness, isolation, private companies not state so politics goes out of the picture. PFI

My RTC guy as an example…..

We are creating MH issue.

Neolib is NOT about the freedom, not about increasing economic well being. for majority, not about soical justice. It is about atomising, isolating, fear, control of civic space, capture of subjectivity.

7. What do we need to do about it.

a. In our theories as well as our practice, we need to keep connecting psychological life with people’s lived experience. To see pay life AS lived experience. So not separate the psychological, or mental life from the other dimensions of life.

We should be good at this. We have an understanding of relationship, the influence of history, childhood, groups. The relationship between the individual and the collective – separateness and connectedness.

b. One way of doing this is find language that connects: like Psychologists Against Austerity slide 83

The Psychological Evidence

Austerity policies have damaging psychological costs, both increasing mental distress in the present and storing problems for the future. This can be demonstrated with robust and well-established psychological research.

We have identified five ‘Austerity Ailments’, which are specific psychological pathways between austerity policies and increased mental distress. These are:

•Humiliation and Shame

◦ Prolonged humiliation following a severe loss trebles the chance of being diagnosed with clinical depression. Shame and humiliation are endemic in experiences of poverty, which has increased during austerity.

•Fear and Mistrust

◦ Austerity has been driven through with a politics of fear and mistrust. Loss of trust underlies several forms of mental distress. Low levels of trust increase the chance of being diagnosed with depression by nearly 50%.

•Instability and Insecurity

◦ Job insecurity, which has increased during austerity, is as damaging for mental health as unemployment.

•Isolation and Loneliness

◦ Austerity has shut down many crucial communal resources. Social isolation is poisonous for mental health and recovery; loneliness is as damaging to health as smoking or drinking alcohol.

•Being Trapped and Powerless

◦ Long term entrapping life experiences nearly treble the chances of being diagnosed with anxiety and depression.

Take Action Against Austerity

PAA briefing paper: 

“Some important indicators of a psychologically healthy society are:

1. Agency

2. Security

3. Connection

4. Meaning

5. Trust

Mental health isn’t just an individual issue. To create resilience and promote wellbeing, we need to look at the entirety of the social and economic conditions in which people live.”

c. Stop diagnosing and enclosing. Stop the superior pay expert shit. Translate our one person, internal work, subjective thinking into something more social and community based.

See here, Community Psychology language: slide 84

d. Engage in new ways of using our skills and commitment to healthy psychological life.

Free Psychotherapy Network and the challenge to money/market. The Gift.

Make lateral links with community groups, food banks, mental health user groups, cuts campaigners, benefits organisations.

e. Acknowledge the need to now campaign for the social values of relationship, cooperation, love, social justice, equality, compassion etc that we therapists hold dear. Campaign against IAPT state therapy. Against enforced therapy for benefits claimants and the disabled. Get a banner – Peoples Assembly march slide 85.  Alliance letter on therapy in job centres. 450 signatures. DPAC, PAA, PCSR (conference in September slide 86), SWAN MH Charter, Boycott Workfare

f. Campaign in our organisations – UKCP, BACP, BPC, training organisations etc – to get them off the apolitical, branding, professionalising agendas. Form our own union?