Published 14 October 202119 November 2021 · Mental health Reclaiming personhood against the rise of mental health discourse Daniel Zola Are we well, Australia? What does it mean to be ‘well’ in 2021? The well-being of society under COVID has become a matter shrouded in fog. GPD and stock market curves have receded into the background, giving way to daily indicators of cases and vaccinations. The lens of ‘public health’ has come to dominate public discussion across a range of areas, and has brought to the fore notions of vulnerability, protection and interconnectedness. Not because of the warmth that those words might in some contexts convey, but as signifiers of a series of risks that are seemingly here to stay. The way we talk about mental health has taken shape within this framing. Initially regarded as a response to the pandemic, psychological distress is now seen by many as a full-blown ‘shadow pandemic’, a material crisis of our neurotransmitters and a social crisis of our resilience in the face of adversity. Worldwide, mental health services have reported unprecedented demand, and notions of decline and suffering that were considered abstract not long ago are now ubiquitous in our culture and relationships. The issue of mental health has been mobilised as a matter of medical intervention, as a logistical challenge, as a cultural pandemic, and as a new frontier for personal development. As such, the efficacy of mental health discourse in capturing the essence of today’s problems and their causes deserves scrutiny. It relates to hereditary mental conditions as well as those of social origin. It covers long-term thought patterns as well as acute short-term responses. It is presided over by psychiatry as well as psychology, psychoanalysis, social work and whatever the ‘wellness industry’ is. With its meaning spread so thin, what does the use of the term today actually convey and entail? Politically, concern for the ‘mental health’ crisis has been used by the left to call for better-funded and integrated care services and networks. This discourse seeks to centre the most vulnerable citizens and illuminate the interconnectedness of the various systems that make up society. The political right, for its part, has instrumentalised this discourse to elevate the harms of lockdown. The political ambivalence of the concept is unsurprising, given the complexity of COVID response measures and how the meanings of ‘health’ and ‘protection’ may differ along social axes including class, race and gender. Even science cannot adequately mediate this ambivalence, with authoritative sources recently reporting that, even as levels of high psychological distress among young people in Australia have doubled during the pandemic, the country has also seen the greatest drop in deaths by suicide in the last decade. The narrative remains wide open. However, ‘mental health’ discourse is not merely a catch-all container for contradictory agendas; is it also shaped by its own social and institutional history. William Davies, in his 2018 book Nervous States, outlines how the early modern era ushered in a view of society as an extended body, with public intellectuals and ‘experts’ treating sociological, political and economic issues as scaled-up anatomical, interpersonal and household concerns. In the late twentieth century, as the social body directed itself to the endless march of progress, so too was public health, including mental health, directed towards the relief and minimisation of any discomforts and pathologies upon the body. This expertise-driven view of health was aligned with the interests of those individuals whose lives and bodies were defined by upward mobility. But what about the downwardly mobile, a category into which so many young people would fall today? For Davies, the idea that what poor and marginalised groups needed was fixes for their discomforts and pathologies conflated two distinct areas of need: on one hand, the very real need for pain relief and anatomical interventions; on the other, the need to regain dignity, recognition and control. As mental health discourse and institutions took on their modern shape, concern for the things that allow individuals to maintain their very personhood was gradually subsumed under a medicalised understanding of all psychosomatic symptoms. This, he argues, is why health professionals face such difficulty not only addressing but even identifying and measuring the increasingly widespread problems of addiction and chronic pain, which straddle both sets of concerns. The more disadvantaged one is in society, the more this tendency to identify the patient with the body produces an alienation between the body and the person. Early in the pandemic, Italian philosopher Giorgio Agamben published a controversial article on the lockdown measures imposed by governments in Italy and elsewhere, centred around his concept of ‘bare life’. This originated in a study of how States instrumentalise people under ‘states of exception’ such as concentration camps and extraordinary rendition sites. Agamben contrasted the mere preservation of human life as a goal of State policy during the pandemic to a more organic approach where the State facilitates human flourishing and personhood within a social whole. It was acknowledged by many on the left that this account of the ideological character of lockdowns was an overreach, as the pandemic was one of those instances when the legitimacy of the State most clearly relied on its effectiveness in preserving human life in the face of our vulnerability to COVID. The argument, however, resonates with keen acuity when addressed to government and institutional responses to the mental health crisis, insofar as it is framed as emergency relief to preserve human life, rather than to sustain the foundations for personhood. These accounts of public health measures describe how the wider the net of ‘mental health’ discourse is cast, the more it performs a certain reduction of the human condition and generates confusion for any attempts to improve social welfare. I argue that this holds true across a range of actors and interventions here in Australia, from the most cynical to the many well-meaning ones. Indeed, the mainstream understanding of ‘mental health’ creates much room for concerns centred around the loss of personhood, even as it views mental health as a problem to be managed. But rather than unifying discussions around how to meet the needs that underly personhood, it only fragments this conversation further. Recent conservative commentary shows clearly the contradiction at the heart of ‘mental health’. Where the manufactured scare around suicide rates relied on the idea that the forced deprivation of material liberties encouraged a retreat into psychic distress, Parnell Palme McGuinness recently warned in an opinion piece that a focus on such vulnerabilities can encourage young people to ‘craft an identity’ around them and coddle themselves rather than ‘getting over it’. This critique would work just as well against right-wing politicians who have used ‘mental health’ as a charade to cover their retreat from the spotlight following political scandals. In a more nuanced opinion piece, Tanveer Ahmed expresses sympathy for the construction workers violently manifesting their anti-vax sentiments outside the CFMEU office in Melbourne. He claims that anti-lockdown arguments related to civil liberties, or to being angry, unheard or mistreated, have been sidelined, while arguments couched in the language of mental health have been granted legitimacy. He sees this language as promoting a defeatist ‘safetyism’, perhaps echoing the more common ‘nanny state’ trope. Interestingly, Ahmed ends the article with a line that would not be out of place in Overland: At a time when we need collective solutions and common purpose, we are offered only the language of mental health and self-care. The left has levelled many critiques against the ubiquitous injunction to practice self-care, but critique of ‘mental health’ discourse has been comparatively restrained. In principle, the left has a responsibility to cultivate care, protection and healing in a traumatic world, at the same time as it aggressively confronts the ravages of capitalism through strikes, rallies and other strategies. In relying on existing institutions and discourses for such needs, however, it risks reproducing the denial of personhood inherent in modern forms of governance. An effective vision of care must be both sword and shield. Stephen Wright eloquently expresses such a vision: … insurrection is built out of care itself and an understanding of its revolutionary and transgressive potential. Care is therefore always militant. Yet when the conversation around mental health becomes centred on a moral imperative, those who would be militant appear to settle for far less. We have to do something Mental health discourse owes much of its recent ascendancy to cultural campaigns that seek to mainstream it—that is, to make it commonplace among various institutions and within otherwise banal daily interactions, just as other campaigns have sought to normalise discussions regarding gender, sexuality, race and disability. RUOK Day represents the most tone-deaf of such campaigns, mired as it is in a corporate model of social therapy, the ‘trickle-down economics of mental health’. Of course, much good has come out of many such campaigns, for it has allowed individuals to express their need for care where previously they might have felt too timid. However, much like money in trickle-down economics, treating mental health as a universal quantity in need of readjustment risks reproducing the powerlessness that pushes many individuals to the brink. Earlier this year, The Guardian Australia conducted a reader survey of experiences with mental illness. The survey hit a nerve, as the number of submissions pushed the newspaper’s editors to the limit of their capacity. The results, which largely related to readers’ experiences with mental health emergencies and their interactions with professionals, were fed into a series of articles that tackled different facets and perspectives on the crisis. The framing was a familiar one—presenting the problem through the lived experience of those affected by it, and adding evidence-based expert analysis on its causes and potential solutions. The survey and subsequent articles integrated a wide range of voices and assembled a useful collection of data points, in the process validating the public mood, driving discussion and lending urgency to what is subjectively and objectively experienced as a crisis. Yet, amid the stories depicting individuals as consumers or victims of a system, there was very little consideration of what we, as a society, should value about human life beyond the preservation of ‘bare life’. During a Guardian Australia podcast interview with Christine Morgan, CEO of the national mental health commission within the Federal Department of Health, the presenter, Katharine Murphy, pondered in truly strange fashion whether or not it might be a good idea to conduct census-level tests of mental health to gauge the depression and suicide risk factors of all Australians. This is less a case of evidence-based methodology and more of a hammer seeing nails everywhere. The truth is that there is no shortage of mental health data across health departments, think tanks, and universities (albeit data that may not account for the circumstances of a global pandemic). We already know that, on average, for every person that commits suicide, there are around twenty-two people who attempt suicide. For every individual who tries, there are between three and four individuals who ideate suicide. For every individual who ideates suicide, there are more than ten who have had twelve-month mental disorders. Here the statistics get a little sketchier. For one, there are many individuals who ideate suicide but never speak to a mental health professional or register their problems with the State in any way. And for every individual who is ideating suicide or at risk of doing so, how many individuals suffered a rapid health decline following an eviction, a redundancy, a Robodebt letter, or some other minor or major catastrophe that a social safety net could have significantly softened? The numbers become harder to match up, but there is enough evidence to draw conclusions about the structural causes of mental health, even if many mental conditions have their own unique determinants. However, even if we change the discourse by stepping away from understanding suicide and mental health problems at the surface level and moving towards a more structural understanding, what kind of solutions are we left with? A technocratic solution to a social and political problem In the May budget, the Federal government announced an increase of mental health spending by $2.3 billion over four years, to be divided among early intervention, suicide prevention, treatment, supporting the vulnerable, and workforce and governance of the sector. One of the most repeated terms in media releases related to the investment was the idea of whole-of-government and whole-of-community programs. In the same Guardian Australia podcast, Christine Morgan explains how a whole-of-government approach builds on the recognition that the sites and the material causes of mental breakdown are widespread throughout society. This approach, as the logic goes, should empower the Mental Health Commission and related bodies to reach across various departments and portfolios to implement good mental health policy. This breaks down silos and bureaucratic barriers to holistic, integrated solutions. For instance, if schools are the best places to attempt interventions that can improve mental health, then such interventions should be coordinated with state departments of education, and education workers should be equipped to pursue and measure mental health outcomes. So far, so good. But let’s unpack this concept. Does the State need to take a ‘whole-of-government’ approach when it comes to the economic bottom line? On some level, it appears so, since—while the Treasury and Reserve Bank are primarily charged with developing monetary and fiscal policy—they work with other government departments and agencies to implement such policies. Yet such an approach would be superfluous as economic models and outcomes already dictate how all government policy is implemented, from reporting to ‘reform’ initiatives. Economic measures not only unify policies and administrations—they define the parameters of the possible and the good. There is no shortage of critiques of how much social policy is driven by a narrow set of economic concerns, nor of alternative measures of societal flourishing, such as Amartya Sen’s capabilities-based approach and Bhutan’s Gross National Happiness Index, both informed by expertise related to mental health outcomes. What a whole-of-government approach promises is a way of co-ordinating and evaluating government policies that reach across society around a fluid, overarching set of mental-health related priorities. Yet, while such an approach may bring to light the interconnected nature of educational and mental health infrastructures, it does not include any provision for significant budgetary increases from the perspective of departments of education. Rather—and here lies the neoliberal core of such an approach—it ties state provision of education to yet another metric. Ultimately, even if it does shift the values of various departments in the right direction, this approach remains a technocratic solution to a political problem—namely, government failures across a range of essential services, including mental health and education. A truly integrated approach complemented by holistic welfare measures would be a universal one that minimises the real burden of accessing education and therapy for all, on the basis that every individual deserves a good education and good therapy. Barack Obama stated in an interview that, in regards to the problem of homelessness, the alternative to defunding the police was to allocate more resources to mental health professionals who could deal with such individuals in a more humane manner. Any good intentions behind this remark veil the obvious point that, rather than attempting to turn mental health professionals into jacks-of-all0trades, perhaps housing providers would be better suited to addressing the issue of homelessness. Australia’s Mental Health Think Tank recommended in its first policy paper the raising of Jobseeker and reintroduction of Jobkeeper as the most effective way of furthering mental health outcomes, insofar as this would alleviate the stress that unemployment exerts upon young people. By highlighting the structural causes of mental health issues, the paper usefully realigns the discussion towards matters of dignity and control. Yet this demand sidesteps the fact that a range of other arguments and campaigns have already failed to force the government’s hand on welfare payments. This is not something the left can afford to do. Reclaiming personhood; reclaiming power Successive State and Federal governments have lowered the bar for satisfactory and expedient public services in the areas of housing, welfare, and employment to the level where securing stable, healthy and fulfilling lives for all Australians is seen as too difficult a challenge and the responsibility is passed on to individuals. The absence of robust universal programs goes hand in hand with the absence of a large-scale consensus on what counts as social goods. Surely, we can do better than the idea that we should prevent people from taking their own lives. Socialist responses to issues such as racism and sexism sometimes stand accused of taking too materialist an approach to issues that are in large part subjective. Yet we cannot rebuild the fragmented self without reclaiming the material dimensions of dignity, recognition and control. Contrary to neoliberal institutions that seek to liberate individuals from their pathologies only to the point where they can participate in the realm of economic necessity, the left must offer a vision of freedom that treats our needs and vulnerabilities as challenges to be collectively grappled with. The very act of building collective, collaborative visions for social goods can rehabilitate a vision of the self not as an atomised unit struggling to cope and manage internal emotions, but as a dynamic, open self with the means to address one’s challenges. This attitude is only as utopian as any act of care that values human life intrinsically. Image by Finn Daniel Zola Daniel Zola is a writer, activist and lawyer based in Sydney. 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