archive.monthlyreview.

org
DOI: 10.14452/MR-070-08-2019-01_5

Capitalism and Mental Health

DAV I D M AT T H E W S

A mental-health crisis is sweeping the globe. Recent estimates by the

World Health Organization suggest that more than three hundred million
people suffer from depression worldwide. Furthermore, twenty-three mil-
lion are said to experience symptoms of schizophrenia, while approximately
eight hundred thousand individuals commit suicide each year.1 Within the
monopoly-capitalist nations, mental-health disorders are the leading cause
of life expectancy decline behind cardiovascular disease and cancer.2 In the
European Union, 27.0 percent of the adult population between the ages of
eighteen and sixty-five are said to have experienced mental-health compli-
cations.3 Moreover, in England alone, the predominance of poor mental
health has gradually increased over the last two decades. The most recent
National Health Service Adult Psychiatric Morbidity Survey illustrates that
in 2014, 17.5 percent of the population over the age of sixteen suffered from
varying forms of depression or anxiety, compared to 14.1 percent in 1993.
Additionally, the number of individuals whose experiences were severe
enough to warrant intervention rose from 6.9 percent to 9.3 percent.4
In capitalist society, biological explanations dominate understandings
of mental health, infusing professional practice and public awareness.
Emblematic of this is the theory of chemical imbalances in the brain—fo-
cusing on the operation of neurotransmitters such as serotonin and do-
pamine—which has gripped popular and academic consciousness despite
remaining largely unsupported.5 Moreover, reflecting the popularity of
genetic reductionism within the biological sciences, there has been an
effort to identify genetic abnormalities as another cause of mental-health
disorders.6 Nonetheless, explanations based on genomics have also failed
to generate conclusive evidence.7 While potentially offering illuminating
insights into poor mental well-being in specific cases, biological interpre-
tations are far from sufficient on their own. What is abundantly clear is
the existence of significant social patterns that elucidate the impossibil-
ity of reducing poor mental health to biological determinism.8
The intimate relationship between mental health and social conditions
has largely been obscured, with societal causes interpreted within a bio-
medical framework and shrouded with scientific terminology. Diagnoses

David Matthews is a lecturer in sociology and social policy at Coleg Llandrillo, Wales,
and the leader of its degree program in health and social care.

49
50 MONTHLY RE V IE W / J an u ary 2019

frequently begin and end with the individual, identifying bioessentialist

causes at the expense of examining social factors. However, the social,
political, and economic organization of society must be recognized as
a significant contributor to people’s mental health, with certain social
structures being more advantageous to the emergence of mental well-
being than others. As the basis on which society’s superstructural forma-
tion is erected, capitalism is a major determinant of poor mental health.
As the Marxist professor of social work and social policy Iain Ferguson
has argued, “it is the economic and political system under which we
live—capitalism—which is responsible for the enormously high levels of
mental-health problems which we see in the world today.” The allevia-
tion of mental distress is only possible “in a society without exploitation
and oppression.”9
In what follows, I briefly sketch the state of mental health in advanced
capitalism, using Britain as an example and utilizing the psychoanalytical
framework of Marxist Erich Fromm, which emphasizes that all humans
have certain needs that must be fulfilled in order to ensure optimal men-
tal health. Supporting Ferguson’s assertion, I argue that capitalism is cru-
cial to determining the experience and prevalence of mental well-being,
as its operations are incompatible with true human need. This sketch
will include a depiction of the politically conscious movement of users
of mental-health services that has emerged in Britain in recent years to
challenge biological explanations of poor mental health and to call for
locating inequality and capitalism at the heart of the problem.

Me n t a l H ea lt h a n d Mo no p o l y Ca p i t a l i s m
In the final chapters of Monopoly Capital, Paul Baran and Paul Sweezy
made explicit the consequences of monopoly capitalism for psychologi-
cal well-being, arguing that the system fails “to provide the foundations
of a society capable of promoting the healthy and happy development of
its members.”10 Exemplifying the widespread irrationality of monopoly
capitalism, they illustrated its degrading nature. It is only for a fortunate
minority that work can be considered pleasurable, while for the ma-
jority it is a thoroughly unsatisfactory experience. Attempting to avoid
work at all costs, leisure frequently fails to offer any consolation, as it is
also rendered meaningless. Rather than being an opportunity to fulfill
passions, Baran and Sweezy argued that leisure has become largely syn-
onymous with idleness. The desire to do nothing is reflected in popular
culture, with books, television, and films inducing a state of passive en-
joyment rather than demanding intellectual energies.11 The purpose of
both work and leisure, they claimed, largely coalesces around increasing
M ental H ealth 51

consumption. No longer consumed for their use, consumer goods have

become established markers of social prestige, with consumption as a
means to express an individual’s social position. Consumerism, howev-
er, ultimately breeds dissatisfaction as the desire to substitute old prod-
ucts for new ones turns maintaining one’s position in society into a re-
lentless pursuit of an unobtainable standard. “While fulfilling the basic
needs of survival,” Baran and Sweezy argued, both work and consump-
tion “increasingly lose their inner content and meaning.”12 The result is
a society characterized by emptiness and degradation. With little likeli-
hood of the working class instigating revolutionary action, the potential
reality is a continuation of the “present process of decay, with the con-
tradictions between the compulsions of the system and the elementary
needs of human nature becoming ever more insupportable,” resulting
in “the spread of increasingly severe psychic disorders.”13 In the current
era of monopoly capitalism, this contradiction remains as salient as ever.
Modern monopoly-capitalist society continues to be characterized by an
incompatibility between, on the one hand, capitalism’s ruthless pursuit
of profit and, on the other, the essential needs of people. As a result,
the conditions required for optimum mental health are violently under-
mined, with monopoly-capitalist society plagued by neuroses and more
severe mental-health problems.

E r ic h Fro m m : Ment a l Hea l t h a n d Hu man Nature

Baran and Sweezy’s understanding of the relationship between monop-
oly capitalism and the individual was significantly influenced by psycho-
analysis. For one, they made references to the centrality of latent energies
such as libidinous drives and the need for their gratification. Moreover,
they accepted the Freudian notion that social order requires the repres-
sion of libidinal energies and their sublimation for socially acceptable pur-
poses.14 Baran himself wrote on psychoanalysis. He had been associated
with the Institute for Social Research in Frankfurt in the early 1930s and
was directly influenced by the work of Eric Fromm and Herbert Marcuse.15
It is within this broad framework that a theory of mental health can be
identified in Baran and Sweezy’s analysis, with the contradictions between
capitalism and human need expressing themselves chiefly through the re-
pression of human energies. It was Fromm, most notably, who was to de-
velop a unique Marxist psychoanalytical position that remains relevant to
understanding mental health in the current era of monopoly capitalism.
And it was from this that Baran, in particular, was to draw.16
While making explicit the importance of Sigmund Freud, Fromm
acknowledged his greater debt to Karl Marx, considering him the
52 MONTHLY RE V IE W / J an u ary 2019

preeminent intellectual.17 Accepting the Freudian premise of the un-

conscious and the repression and modification of unconscious drives,
Fromm nonetheless recognized the failure of orthodox Freudianism to
integrate a deeper sociological understanding of the individual into its
analysis. Turning to Marxism, he constructed a theory of the individual
whose consciousness is shaped by the organization of capitalism, with
unconscious drives repressed or directed toward acceptable social be-
havior. While Marx never produced a formal psychology, Fromm consid-
ered that the foundations of one resided in the concept of alienation.18
For Marx, alienation was an illustration of capitalism’s mortifying phys-
ical and mental impact on humans.19 At its heart, it demonstrates the
estrangement people feel from both themselves and the world around
them, including fellow humans. Alienation’s specific value for under-
standing mental health lies in illustrating the distinction that emerg-
es under capitalism between human existence and essence. For Marx,
capitalism separates individuals from their essence as a consequence
of their existence. This principle permeated Fromm’s psychoanalytic
framework, which maintained that, under capitalism, humans become
divorced from their own nature.
Human nature, Marx argued, consists of dual qualities and we “must
first deal with human nature in general, and then with human nature as
modified in each historical epoch.”20 There are needs that are fixed, such
as hunger and sexual desires, and then there are relative desires that orig-
inate from the historical and cultural organization of society.21 Inspired
by Marx, Fromm argued that human nature is inherent in all individu-
als, but that its visible manifestation is largely dependent on the social
context. It is untenable to assume “man’s mental constitution is a blank
piece of paper, on which society and culture write their text, and which
has no intrinsic quality of its own.… The real problem is to infer the core
common to the whole human race from the innumerable manifestations
of human nature.”22 Fromm recognized the importance of basic biological
needs, such as hunger, sleep, and sexual desires, as constituting aspects
of human nature that must be satisfied before all else.23 Nonetheless, as
humans evolved, they eventually reached a point of transcendence, from
the animal to the uniquely human.24 As humans found it increasingly
easier to satisfy their basic biological needs, largely as a result of their
mastery over nature, the urgency of their satisfaction gradually became
less important, with the evolutionary process allowing for the develop-
ment of more complex intellectual and emotional capacities.25 As such,
an individual’s most significant drives were no longer rooted in biology,
but in the human condition.26
M ental H ealth 53

Considering it imperative to construct an understanding of human na-

ture against which mental health could be evaluated, Fromm identified
five central characteristics of the human condition. The first is related-
ness. Aware of being alone in the world, humans strenuously endeavor
to establish ties of unity. Without this, it is intolerable to exist as an in-
dividual.27 Second, the dominance of humans over nature allows for an
easier satisfaction of biological needs and for the emergence of human
aptitudes, contributing to the development of creativity. Humans devel-
oped the ability to express a creative intelligence, transforming this into
a core human characteristic that requires fulfillment.28 Third, humans,
psychologically, require rootedness and a sense of belonging. With birth
severing ties of natural belonging, individuals constantly pursue rooted-
ness to feel at one with the world. For Fromm, a genuine sense of belong-
ing could only be achieved in a society built on solidarity.29 Fourth, hu-
mans crucially desire and develop a sense of identity. All individuals must
establish a sense of self and an awareness of being a specific person.30
Fifth, it is psychologically necessary for humans to develop a framework
through which to make sense of the world and their own experiences.31
Representing what Fromm argued to be a universal human nature, the
satisfaction of these drives is essential for optimum mental well-being. As
he contended, “mental health is achieved if man develops into full matu-
rity according to the characteristics and laws of human nature. Mental ill-
ness consists in the failure of such development.”32 Rejecting a psychoan-
alytical understanding that emphasizes the satisfaction of the libido and
other biological drives, mental health, he claimed, is inherently associat-
ed with the satisfaction of needs considered uniquely human. Under capi-
talism, however, the full satisfaction of the human psyche is thwarted.
For Fromm, the origins of poor mental health are located in the mode of
production and the corresponding political and social structures, whose
organization impedes the full satisfaction of innate human desires.33 The
effects of this on mental health, Fromm argued, are that “if one of the
basic necessities has found no fulfillment, insanity is the result; if it is
satisfied but in an unsatisfactory way…neurosis…is the consequence.”34

Wo r k a n d C reat i ve Rep res s i o n

Like Marx, Fromm asserted that the instinctual desire to be creative
had the greatest chance of satisfaction through work. In the Economic and
Philosophic Manuscripts of 1844, Marx strenuously argued that labor should be
a fulfilling experience, allowing individuals to be freely expressive, both
physically and intellectually. Workers should be able to relate to the prod-
ucts of their labor as meaningful expressions of their essence and inner
54 MONTHLY RE V IE W / J an u ary 2019

creativity. Labor under capitalism, however, is an alienating experience

that estranges individuals from its process. Alienated labor, Marx contend-
ed, is when “labour is external to the worker, i.e., it does not belong to his
essential being…therefore, he does not affirm himself but denies himself,
does not feel content but unhappy, does not develop freely his physical
and mental energy but mortifies his body and ruins his mind.”35 Under
capitalism, great efforts are made to ensure human energy is channeled
into labor, even though it is often miserable and tedious.36 Rather than
satisfying the need to express creativity, it frequently represses it through
the monotonous and grueling obligation of wage labor.37
In Britain, there is widespread dissatisfaction with work. One recent
survey of employees conducted in early 2018 estimated that 47 percent
would consider looking for a new job during the coming year. Of the
reasons given, a paucity of opportunities for career advancement was
prominent, along with not enjoying work and employees feeling like
they do not make a difference.38 These reasons begin to illustrate an
entrenched alienation from the labor process. Many people experience
work as having little meaning and little opportunity for personal fulfill-
ment and expression.
From such evidence, a claim can be made that in Britain—as in many
monopoly-capitalist nations—a substantial portion of the labor force
feels disconnected from their work and does not consider it a creative
experience. For Fromm, the realization of creative needs are essential to
being mentally healthy. Having been endowed with reason and imagina-
tion, humans cannot exist as passive beings, but must act as creators.39
Nevertheless, it is clear that work under capitalism does not achieve this.
Considerable evidence suggests that far from being beneficial to mental
health, work is actually detrimental to it. Although the exact figures are
likely to remain unknown due to the intangibility of such experiences,
it can be inferred that, for many members of the labor force, it is com-
monplace for work to provoke general unhappiness, dissatisfaction, and
despondency. Moreover, more severe mental-health conditions, such as
stress, depression, and anxiety, are increasingly emerging as the conse-
quences of discontentment at work. In 2017–18, such conditions consti-
tuted 44 percent of all work-related ill health in Britain, and 57 percent of
all workdays lost to ill health.40 An additional study in 2017 estimated that
60 percent of British employees had suffered work-related poor mental
health in the past year, with depression and anxiety being some of the
most common manifestations.41
Rather than a source of enjoyment, the nature and organization of
work under capitalism clearly does not act as a satisfactory means to
M ental H ealth 55

fulfill an individual’s creativity. As Baran and Sweezy argued, “the work-

er can find no satisfaction in what his efforts accomplish.”42 Instead,
work alienates individuals from a fundamental aspect of their nature
and, in so doing, stimulates the emergence of varying negative states
of mental health. With around half of the labor force in Britain having
experienced work-related mental-health issues, and many more likely
feeling a general sense of despondency, there exists what Fromm termed
a socially patterned defect.43 It is no exaggeration to argue that the de-
terioration of mental well-being is a standard response to wage labor in
monopoly-capitalist societies. Negative feelings become commonplace
and, to varying degrees, are acknowledged as normal reactions to work.
With the exception of severe mental-health disorders, many forms of
mental distress that develop in response are taken for granted and not
considered legitimate problems. As such, the degradation of mental
well-being is normalized.

M ea n in gf u l A s s o c i at i o n a nd Lo n el i n ess
For Fromm, there existed an inherent relationship between positive
mental health, meaningful personal relationships in the form of both
love and friendship, and expressions of solidarity. Acutely aware of their
“aloneness” in the world, individuals attempt to escape the psychologi-
cal prison of isolation.44 Nonetheless, the operation of capitalism is such
that it frequently prevents the satisfactory fulfillment of this need. The
inadequacy of social relationships within monopoly-capitalist societies
was identified by Baran and Sweezy. They argued a frivolity had de-
scended over much social interaction, as it became typified by super-
ficial conversation and a falsity of pleasantness. The emotional com-
mitments required for friendship and the intellectual efforts needed
for conversation were made largely absent as social interaction became
increasingly about acquaintances and small talk.45 Contemporary mo-
nopoly capitalism is no exception. While difficulties in measuring its
existence and nature abound, arguably one the most widespread neu-
roses to plague present-day capitalism is loneliness. It is increasingly
considered a major public-health concern, perhaps most symbolically
evident with the establishment of a Minister for Loneliness in 2018 by
the British government.
As a neurosis, loneliness has debilitating consequences. Individuals
may resort to alcohol and drug abuse to numb their misery, while per-
sistent experience increases blood pressure and stress, as well as nega-
tively impacts cardiovascular and immune-system functioning.46 A men-
tal-health condition in its own right, loneliness exacerbates additional
56 MONTHLY RE V IE W / J an u ary 2019

mental-health problems and is often the root cause of depression.47 In

2017, it was estimated that 13 percent of individuals in Britain had no
close friends, with a further 17 percent having average- to poor-quality
friendships. Moreover, 45 percent claimed to have felt lonely at least once
in the previous two weeks, with 18 percent frequently feeling lonely.
Although a close, loving relationship acts as a barrier to loneliness, 47
percent of people living with a partner reported feeling lonely at least
some of the time and 16 percent often.48 Reflecting the dominant scien-
tific constructs of mental health, recent efforts have been made to iden-
tify genetic causes of loneliness, with environmental conditions said to
exacerbate an individual’s predisposition to it.49 However, even the most
biologically deterministic analyses concede that social circumstances are
important to its development. Nonetheless, few studies attempt to seri-
ously illustrate the extent to which capitalism is a contributing factor.
Individualism has always reigned supreme as a principle upon which the
ideal capitalist society is constructed. Individual effort, self-reliance, and
independence are endorsed as the hallmarks of capitalism. As understood
today, the notion of the individual has its origins in the feudal mode of
production, and its emphasis on greater collectivist methods of labor—
such as within the family or village—being surrendered to the compul-
sion of individuals, who have to be free to sell their labor power on the
market. Prior to capitalism, life was conducted more as part of a wider
social group, while the transition to capitalism developed and allowed for
the emergence of the isolated, private individual and the nuclear, increas-
ingly privatized family.50 Fromm contended that the promotion and cel-
ebration of the virtues of the individual means that members of society feel
more alone under capitalism than under previous modes of production.51
Capitalism’s exaltation of the individual is made further apparent by its po-
tent opposition to the ideals of collectivism and solidarity, and preference
and incentive for competition. Individuals, it is said, must compete with
each other on a general basis to enhance their personal development. More
specifically, competition is, economically, one of the bases on which the
market operates and, ideologically, corresponds to the widespread belief
that, to be successful, one must compete with others for scarce resources.
The consequence of competition is that it divides and isolates individuals.
Other members of society are not considered as sources of support, but
rather obstacles to personal advancement. Ties of social unity are therefore
greatly weakened. Thus, loneliness is embedded within the structure of
any capitalist society as an inevitable outcome of its value system.
Not only is loneliness integral to capitalist ideology, it is also exacer-
bated by the very functioning of capitalism as a system. As a result of
M ental H ealth 57

capitalism’s inexorable drive for self-expansion, the growth of produc-

tion is one of its elementary characteristics. Having become an axiomatic
notion, rarely is the idea of expanded production challenged. The human
cost of this is crippling as work takes precedence over investing in social
relationships. Furthermore, neoliberal reforms have left many workers
with progressively more precarious jobs and less protections, guaranteed
benefits, and hours of employment—all of which have only aggravated
loneliness. Amplifying the proletarianization of the labor force, with
ever-more workers existing in a state of insecurity and experiencing in-
creased exploitation, the centrality of work has become greater as the
threat of not having a job, or being unable to secure an adequate standard
of living, has become a reality for many in a “flexible” labor market.52
Individuals have no choice but to devote more time to work at the ex-
pense of establishing meaningful relationships.
The growing attention given to work can be illustrated in relation to
working practices. Despite the fact that the average length of the work-
ing week increased in Britain following the financial crisis of 2007–09,
the broader picture over the last two decades has officially been one of
decline. Part-time workers, however, have witnessed the number of hours
they work increase, along with the number of part-time jobs. Additionally,
between 2010 and 2015, there was a 15 percent rise in the number of full-
time members of the labor force working more than forty-eight hours per
week (the legal limit; additional hours must be agreed upon by employer
and employee).53 Furthermore, in 2016, one employee survey illustrated
that 27 percent worked longer than they would like, negatively impacting
their physical and mental health, and 31 percent felt that their work in-
terfered with their personal life.54 Significantly, loneliness is not just a fea-
ture of life outside of work, but a common experience during work. In 2014,
it was estimated that 42 percent of British employees did not consider any
coworker to be a close friend, and many felt isolated in the workplace.
Greater engagement in productive activities at the expense of person-
al relationships has been labeled the “cult of busyness” by psychiatrists
Jacqueline Olds and Richard Schwartz.55 While they accurately identify
this trend, they nonetheless evaluate it in terms of workers freely choos-
ing such a life. This elides any serious criticisms of capitalism and the
reality that the cult of busyness has largely been an outcome of the eco-
nomic system’s inherent need for self-expansion. Furthermore, Olds and
Schwartz fail to accept the trend as a reflection of the structural organi-
zation of the labor market, which makes more work a necessity instead
of a choice. The avoidance of loneliness and the search for meaningful
relationships are fundamental human desires, but capitalism suppresses
58 MONTHLY RE V IE W / J an u ary 2019

their satisfactory fulfillment, along with the opportunities to form com-

mon bonds of love and friendship, and to work and live in solidarity.
In response, as Baran and Sweezy argued, the fear of being alone drives
people to seek some of the least fulfilling social relationships, which ulti-
mately result in feelings of greater dissatisfaction.56

Mat e r ia lis m a n d t he Sea rc h fo r Id en t i t y and Creativ ity

For monopoly capitalism, consumption is a vital method of surplus ab-
sorption. In the era of competitive capitalism, Marx could not foresee how
the sales effort would evolve both quantitatively and qualitatively to be-
come as important for economic growth as it has.57 Advertising, product
differentiation, planned obsolescence, and consumer credit are all essen-
tial means of stimulating consumer demand. At the same time, there is
no shortage of individuals willing to consume. Alongside the acceptance
of work, Fromm identified the desire to consume as an integral character-
istic of life under capitalism, arguing it was a significant example of the
uses to which human energies are directed to support the economy.58
With consumer goods valued for their conspicuity rather than their
intended function, people have gone from consuming use values to sym-
bolic values. The decision to engage in popular culture and purchase
a type of automobile, brand of clothing, or technological equipment,
among other goods, is frequently based on what the product is supposed
to convey about the consumer. Frequently, consumerism constitutes the
principal method through which individuals can construct a personal
identity. People are emotionally invested in the meanings associated
with consumer goods, in the hope that whatever intangible qualities
items are said to possess will be passed on to them through ownership.
Under monopoly capitalism, consumerism is more about consuming
ideas and less about satisfying inherent biological and psychological
needs. Fromm contended that “consumption should be a concrete hu-
man act in which our senses, bodily needs, our aesthetic taste…are in-
volved: the act of consumption should be a meaningful…experience. In
our culture, there is little of that. Consuming is essentially the satisfac-
tion of artificially stimulated phantasies.”59
The need for identity and creative fulfillment encourages an insatiable
appetite to consume. Each purchase, however, regularly fails to live up to
its promise. Rarely is satisfaction truly achieved through consumption,
because what is being consumed is an artificial idea rather than a prod-
uct that imbues our existence with meaning. In this process, consum-
erism as a form of alienation becomes evident. Instead of consuming a
product designed to satisfy inherent needs, consumer goods exemplify
M ental H ealth 59

their synthetic nature via their manufactured meanings and symbolisms,

which are designed to stimulate and satisfy a preplanned response and
need.60 Any identity a person may desire, or feel they have obtained, from
consuming a product, as well as any form of creativity invoked by a con-
sumer good or item of popular culture, is false.
Rather than cultivating joy, the affluence of the monopoly-capitalist
nations has bred a general widespread dissatisfaction as high value is
placed on amassing possessions. While consumerism as a value exists in
all capitalist societies, in those of greater inequality—with Britain dis-
playing wider wealth disparities than most—the desire to consume and
acquire greatly contributes to the emergence of neuroses, as the effort to
maintain social status and emulate those at the top of society becomes an
immense strain. The impact of this has been demonstrated within British
families in recent years. In 2007, UNICEF identified Britain as having the
lowest level of child well-being out of twenty-one of the most affluent
Organisation for Economic Co-operation and Development nations. In re-
sponse, an analysis of British families was conducted in 2011 comparing
them to those in Spain and Sweden, countries that ranked in the top five
for child well-being.61
Of the three nations, the culture of consumerism was greatest in Britain,
as it was prevalent among all families regardless of affluence. British par-
ents were considered more materialistic than their Spanish and Swedish
counterparts and behaved accordingly toward their children. They pur-
chased the most up-to-date, branded consumer goods, largely because they
thought it would ensure their child’s status among their peers. This was
a value shared by the children themselves, with many accepting that so-
cial prestige was based on ownership of branded consumer goods, which,
evidence suggests, contributed to arising worry and anxiety, especially
for children from poorer households who recognized their disadvantage.
While a compulsion to purchase new goods continuously for themselves
and their children was identified among British parents, many nonethe-
less also felt the psychological strain of attempting to maintain a mate-
rialistic lifestyle and caved to such pressures. Across all three countries,
children identified the needs for their own well-being as consisting of
quality time spent with parents and friends, and opportunities to indulge
their creativity, especially through outdoor activities. Despite this, the re-
search showed that, in Britain, many were not having such needs satisfied.
Parents struggled to spend enough time with their children due to work
commitments and often prevented them from participating in outdoor ac-
tivities due to safety concerns. Subsequently, parents compensated for this
with consumer goods, which largely failed to meet their children’s needs.
60 MONTHLY RE V IE W / J an u ary 2019

As such, the needs of British children to form and partake in meaningful

relationships and act creatively were repressed, and efforts to satisfy these
needs through consumerism failed to bring them happiness.

Res is t a n c e a s Cl a s s St rug g l e
While not denying the existence of biological causes, the structural or-
ganization of society must be recognized as having serious repercussions
on people’s mental health. Monopoly capitalism functions to prevent
many from experiencing mental well-being. Yet, despite this, the medical
model continues to dominate, reinforcing an individualistic conception
of mental health and obscuring the detrimental effects of the present
mode of production. This oppresses users of mental-health services by
subordinating them to the judgment of medical professionals. The medi-
cal model also encourages the suspension and curtailment of individuals’
civil rights if they experience mental distress, including by legitimizing
the infringement of their voluntary action and excluding them from de-
cision-making. For those who suffer mental distress, life under capitalism
is frequently characterized by oppression and discrimination.
Aware of their oppressed status, users and survivors of mental-health
services are now challenging the ideological dominance of the medi-
cal model and its obfuscation of capitalism’s psychological impact.
Furthermore, they are increasingly coalescing around and putting for-
ward as an alternative the need to accept the Marxist-inspired social mod-
el of mental health. The social model of disability identifies capitalism
as instrumental to the construction of the category of disability, defined
as impairments that exclude people from the labor market. Adopting a
broadly materialist perspective, a social model of mental health addresses
material disadvantage, oppression, and political exclusion as significant
causes of mental illness.
In 2017 in Britain, the mental-health action group National Survivor
User Network unequivocally rejected the medical model and planted so-
cial justice at the heart of its campaign. As part of its call for a social ap-
proach to mental health, the group explicitly denounces neoliberalism,
arguing that austerity and cuts to social security have contributed to the
increasing prevalence of individuals who suffer from poor mental health
as well as to the exacerbation of existing mental-health issues among the
population. Recognizing social inequality as a contributor to the emer-
gence of poor mental health, National Survivor User Network proposes
that the challenge posed by mental-health service users should be part
of a wider indictment of the general inequality in society, arguing that
“austerity measures, damaging economic policies, social discrimination
M ental H ealth 61

and structural inequalities are causing harm to people. We need to chal-

lenge this as part of a broader social justice agenda.”62 Furthermore, the
action group Recovery in the Bin positions itself and the wider mental-
health movement within the class struggle, pushing for a social model
that recognizes capitalism as a significant determinant of poor mental
health. Moreover, representing ethnic minorities, Kindred Minds vigor-
ously campaigns on an understanding that mental distress is less a result
of biological characteristics and more a consequence of social problems
such as racism, sexism, and economic inequality “pathologised as mental
illness.”63 For Kindred Minds, the catalyst for deteriorating mental health
is oppression and discrimination, with ethnic minorities having to suffer
greater levels of social and economic inequality and prejudice.
Capitalism can never offer the conditions most conducive to achieving
mental health. Oppression, exploitation, and inequality greatly repress
the true realization of what it means to be human. Opposing the brutal-
ity of capitalism’s impact on mental well-being must be central to the
class struggle as the fight for socialism is never just one for increased
material equality, but also for humanity and a society in which all human
needs, including psychological ones, are satisfied. All members of society
are affected by the inhumane nature of capitalism, but, slowly and de-
terminedly, the fight is being led most explicitly by the most oppressed
and exploited. The challenge posed must be viewed as part of the wider
class struggle, as being one front of many in the fight for social justice,
economic equality, dignity, and respect.

Notes
1. World Health Organization, Fact
Sheets on Mental Health (Geneva: World
Health Organization, 2017), http://who.
int.
2.  World Health Organization, Data and
Resources (Geneva: World Health Orga�-
nization, 2017), http://euro.who.int/en.
3.  World Health Organization, Data and
Resources.
4. Sally McManus, Paul Bebbington,
Rachel Jenkins, and Traolach Brugha,
Mental Health and Wellbeing in England:
Adult Psychiatric Morbidity Survey 2014
(Leeds: NHS Digital, 2016).
5.  Brett J. Deacon and Dean McKay, “The
Biomedical Model of Psychological Prob-
lems: A Call for Critical Dialogue,” Behav-
ior Therapist 38, no. 7 (2015): 231–35.
Pharmaceutical companies who have
identified it as a market opportunity have
been the primary beneficiaries of this
approach, exemplified by the prolifera-
tion of anti-depressants as illustrated by
Brett J. Deacon and Grayson L. Baird, “The
Chemical Imbalance Explanation of De-
pression: Reducing Blame at what Cost?,”
Journal of Social and Clinical Psychology
28, no. 4 (2009): 415–35.
6.  As exemplified by Jordan W. Smoller
et al., “Identification of Risk Loci with
Shared Effects on Five Major Psychiatric
Disorders: A Genome-Wide Analysis,”
Lancet 381, no. 9875 (2013): 1371–79.
In this study, five of the most common
mental-health disorders, including
schizophrenia, bipolar disorder, and de-
pression, were associated with genetic
variations.
7.  Deacon and McKay, “The Biomedical
Model of Psychological Problems,” 233.
8.  Social class is one of the most sig-
nificant indicators of mental health, as
evidenced by research within the social
sciences dating back to the earlier part
of the twentieth century. The first most
notable study of this kind is Robert E. L.
Farris and Henry W. Dunham, Mental Dis-
orders in Urban Areas (Chicago: Chicago
University Press, 1939), which identi-
fied higher rates of mental disorders
in the poorest districts of Chicago. This
was followed by, among others in both
Britain and the United States, August B.
Hollingshead and Frederick C. Redlich,
Social Class and Mental Illness (New York:
John Wiley, 1958); Leo Srole, Thomas
S. Langer, Stanley T. Michael, Marvin K.
Opler, and Thomas A. C. Rennie, Mental
Health in the Metropolis: The Midtown
Manhattan Study (New York: McGraw-
Hill, 1962); and John J. Schwab, Roger
A. Bell, George J. Warheit, and Ruby B.
Schwab, Social Order and Mental Health:
The Florida Health Study (New York: Brun-
ner-Mazel, 1979).
9. Iain Ferguson, Politics of the Mind:
Marxism and Mental Distress (London:
Bookmarks, 2017), 15–16.
10.  Paul Baran and Paul Sweezy, Monop-
oly Capital (New York: Monthly Review
Press, 1966), 285.
11.  Baran and Sweezy, Monopoly Capi-
62 MONTHLY
tal, 346–47.
12.  Baran and Sweezy, Monopoly Capi-
tal, 346.
13.  Baran and Sweezy, Monopoly Capi-
tal, 364.
14.  Baran and Sweezy, Monopoly Capi-
tal, 354–55.
15.  Paul A. Baran, The Longer View (New
York: Monthly Review Press, 1969),
92–111; Paul M. Sweezy, “Paul A. Baran:
A Personal Memoir,” in Paul A. Baran: A
Collective Portrait (New York: Monthly
Review Press, 32–33. The unpublished
chapter of Baran and Sweezy’s Monopoly
Capital, entitled “The Quality of Monopo-
ly Capitalist Society II,” drafted by Baran,
had included an extensive section on
mental health. That chapter, however,
was not included in the book because it
was still unfinished at the time of Baran’s
death. Nevertheless, some elements
of the mental-health argument were
interspersed in other parts of the book.
When “The Quality of Monopoly Capital-
ism II” was finally published in Monthly
Review in 2013, almost sixty years after
it was drafted by Baran, the section on
mental health was excluded due to its
incomplete character. See Paul A. Baran
and Paul M. Sweezy, “The Quality of Mo�-
nopoly Capitalist Society: Culture and
Communications” Monthly Review 65,
no. 3 (July–August 2013): 43–64. It is
worth noting that the treatment of men-
tal health in Monopoly Capital did not go
unnoticed and was subject to criticism by
Robert Heilbroner in a review in the New
York Review of Books, to which Sweezy re-
sponded in a letter, defending their anal-
ysis in this regard. See Robert Heilbroner,
Between Capitalism and Socialism (New
York: Vintage, 1970), 237–46; Paul M.
Sweezy, “Monopoly Capital” (letter), New
York Review of Books, July 7, 1966, 26.
16.  The influence of Fromm is evident
in Baran’s work and correspondence.
He studied Fromm’s The Sane Society,
together with Marcuse’s Eros and Civi-
lization and One Dimensional Man (in
manuscript form). He was undoubtedly
familiar with the wider body of work by
both thinkers. While Baran was not in
complete agreement with the details of
Marcuse’s analyses, he openly acknowl-
edged the importance and significance
of his work, identifying Eros and Civili-
zation as having great relevance to U.S.
society and recognizing a psychoana-
lytical analysis as vital to understanding
monopoly-capitalist society. See Nicholas
Baran and John Bellamy Foster, The Age
of Monopoly Capital: Selected Corre-
spondence of Paul A. Baran and Paul M.
Sweezy, 1949–1964 (New York: Monthly
Review Press, 2017), 127, 131. See also
the “Baran-Marcuse Correspondence,”
Monthly Review Foundation, http://
monthlyreview.org.
RE V IE W
17.  Erich Fromm, Beyond the Chains of
Illusion: My Encounter with Freud and
Marx (London: Continuum, 2009), 7.
18. Fromm, Beyond the Chains of Illu-
sion, 35.
19. Bertell Ollman, Alienation: Marx’s
Conception of Man in a Capitalist Society
(Cambridge: Cambridge University Press,
1977), 131.
20.  Karl Marx, Capital, vol. 1 (1867; repr.
London: Lawrence and Wishart, 1977),
571.
21.  Erich Fromm, Marx’s Concept of Man
(London: Bloomsbury, 2016), 23–24.
22.  Erich Fromm, The Sane Society (Lon-
don, Routledge, 2002), 13.
23. Fromm, The Sane Society, 65.
24. Fromm, The Sane Society, 22.
25. Fromm, Beyond the Chains of Illu-
sion, 27.
26. Fromm, The Sane Society, 27.
27. Fromm, The Sane Society, 28–35.
28. Fromm, The Sane Society, 35–36.
29. Fromm, The Sane Society, 37–59.
30. Fromm, The Sane Society, 59–61.
31. Fromm, The Sane Society, 61–64
32. Fromm, The Sane Society, 14.
33. Fromm, The Sane Society, 76.
34. Fromm, The Sane Society, 66.
35.  Karl Marx, Economic and Philosophic
Manuscripts of 1844 (1932; repr. Rad-
ford, Virginia: Wilder Publications, 2011).
36. Fromm, Beyond the Chains of Illu-
sion, 63.
37. Fromm, The Sane Society, 173.
38. Investors in People, Job Exodus
Trends: 2018 Employee Sentiment Poll
(London: Investors in People, 2018),
http://investorsinpeople.com.
39. Fromm, The Sane Society, 35.
40. Health and Safety Executive, Work
Related Stress, Depression or Anxiety
Statistics in Great Britain, 2018 (Bootle,
UK: Health and Safety Executive, 2018),
3, http://hse.gov.uk.
41.  Business in the Community, Mental
Health at Work Report 2017 (London:
Business in the Community, 2017),
http://bitc.org.uk.
42.  Baran and Sweezy, Monopoly Capi-
tal, 345.
43. Fromm, The Sane Society, 15.
44. Fromm, The Sane Society, 29.
45.  Baran and Sweezy, Monopoly Capi-
tal, 347–48.
46.  Jo Griffin, The Lonely Society? (Lon-
don: Mental Health Foundation, 2010),
6–7.
47. Griffin, The Lonely Society?, 4
48.  David Marjoribanks and Anna Dar-
/ J an u ary 2019
nell Bradley, You’re Not Alone: The Qual-
ity of the UK’s Social Relationships (Don-
caster: Relate, 2017), 17–18.
49.  Luc Goossens, Eeske van Roekel, Ma-
aike Verhagen, John T. Cacioppo, Stepha-
nie Cacioppo, Marlies Maes, and Dorret I.
Boomsma, “The Genetics of Loneliness:
Linking Evolutionary Theory to Genome-
Wide Genetics, Epigenetics, and Social
Science,” Perspectives on Psychological
Science 10, no 2 (2015): 213–26.
50. Michael Oliver, The Politics of Dis-
ablement (Basingstoke, UK: Macmillan
Press, 1990); Eli Zaretsky, Capitalism, the
Family, and Personal Life (London: Pluto
Press, 1976).
51. Fromm, The Fear of Freedom, 93.
52.  See Ricardo Antunes, “The New Ser� -
vice Proletariat,” Monthly Review 69, no.
11 (April 2018): 23–29, for an analysis of
the evolving insecurity of labor markets
within the advanced capitalist nations
and the hardening of proletarian divi-
sions.
53. Trade Union Congress, “15 Per
Cent Increase in People Working More
than 48 Hours a Week Risks a Return to
‘Burnout Britain’, Warns TUC,” September
9, 2015; Josie Cox, “British Employees
are Working More Overtime than Ever
Before—Often for No Extra Money,” Inde-
pendent, March 2, 2017.
54. David Marjoribanks, A Labour of
Love—or Labour Versus Love?: Our Re-
lationships at Work; Relationships and
Work (Doncaster: Relate, 2016).
55.  Jacqueline Olds and Richard
Schwartz, The Lonely American: Drifting
Apart in the Twenty-First Century (Boston:
Beacon Press, 2009).
56.  Baran and Sweezy, Monopoly Capi-
tal, 347–48.
57.  Baran and Sweezy, Monopoly Capi-
tal, 115.
58. Fromm, Beyond the Chains of Illu-
sion, 63.
59. Fromm, The Sane Society, 129-130.
60. Robert Bocock, Consumption (Lon-
don: Routledge, 2001), 51.
61.  United Nations Children’s Fund, In-
nocenti Report Card 7: Child Poverty in
Perspective: An Overview of Child Well-
Being in Rich Countries (Florence: UNI-
CEF Innocenti Research Centre, 2007),
http://unicef-irc.org.
62. National Survivor User Network,
NSUN Manifesto 2017: Our Voice, Our
Vision, Our Values, (London: National
Survivor User Network, 2017), http://
nsun.org.uk.
63.  Raza Griffiths, A Call for Social Jus-
tice: Creating Fairer Policy and Practice for
Mental Health Service Users from Black
and Minority Ethnic Communities (Lon-
don: Kindred Minds, 2018).
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