I’m a Marxist, and my Marxism is integral to my understanding of insanity. I don’t mean that in a biological or medical sense; I’m not a Soviet anti-psychiatrist, insisting that all mental illness is a byproduct of the present mode of production (although surely some of that millennial Anxiety and Depression(TM) is). I believe that my particular illness, and most severe mental illness, is a product of biology and interpersonal circumstance, and that these illnesses have existed across cultures and histories. But mental illness is also a political problem, a problem of healthcare and housing and employment and criminal-justice; the mentally ill are a subset of society with particular abilities and particular needs, and as with all political questions, I believe that a Marxist, materialist outlook is the best way to get at what is going on, and what, if anything, is liable to remedy the situation.
My Marxism is part of what makes me so skeptical of anti-stigma rhetoric. The destigmatizers are classic liberals and idealists in their outlook. They believe that society and politics proceeds from people’s ideas about the world; therefore, if people in general were only more understanding and compassionate toward the mentally ill, then they would treat us better and improve our circumstances. I’m a materialist. I believe stigma, inasmuch as it’s a problem, is an ideological consequence of the material condition of the mentally ill. We are not, in general, particularly productive members of society. We tend to consume more resources than we produce. Worse, the worst of us tend to be disruptive; difficult or criminal, unclean or weird, and so it is no surprise that given how little use we are to really any mode of production, nearly every mode of production has given rise to an ideological rationale for hating and maligning us. If you want to end stigma, then improve the material condition of the lunatics. Ideology and sentiment will change accordingly.
Mental illness is not the only part of our discourse dominated by an idealist theory of politics, of course. A great deal of liberal and even purportedly-left thinking about race, gender, sexual orientation, even class, proceeds from the premise that ideas drive politics and therefore if we educate people—or, as is often demanded, they educate themselves, banishing the metaphysical taint of bigotry from their hearts, presumably in order to please the liberal arts graduates who keep calling them assholes— then, and only then, will material iniquities begin to change. Get rid of all the stigmas and isms, and the coalition of the woke will fix the world, this discourse says. Of course, this discourse is precisely wrong and backward. Basic materialism is right: Correct the hierarchical distribution of material goods, and therefore the hierarchical distribution of power, and only then will all the ideas which have sprung up to justify the current hierarchies begin to wither from lack of usefulness. One doesn’t have to be a communist, or even a full Marxist to believe this. You only have to accept that first premise: the world of ideas reflects the world of things, not the other way around. Goods are distributed and certain way, and politics largely functions to explain why that’s Good, Actually. Base and superstructure. Material and ideology.
What I find particularly frustrating, both in general and in the case of insanity politics, is how many people even on the alleged left, how many people who self-identify as Marxists, are nonetheless fundamentally idealists. This is true in marginalization discourse — they tend to be among the most prominent destigmatizers and wokescolds — but it’s most obviously manifest in their ongoing obsession with individuals as the battlefield of politics.
I expect this has something to do with the huge influx of new and particularly young people into the so-called American left over the past few years. They’ve come over to the “right team” in the sense that they can correctly identify the broad contending classes of a socialist left account of the world, but are still basically liberal in their sense of how that conflict takes place. They still have a Manichean view of morality, where there are Good People and Bad People, and what kind of person you are in some way reflects your individual choices about the state of your soul. They tend to believe bankers and landlords are Bad People, rather than believing wealth itself is the moral bad. They hunt for metaphysical Predators (often, ironically, described with the very mental health vernacular of sociopaths and narcissists they claim to want to disassociate with intrinsic criminality), rather than paying anything more than lip-service to the structural conditions that give rise to predation. They claim to hate the defensive “a few bad apples” theory of racist cops, but they only seem to take issue with the words “a few”, instead believing that the kinds of people who become cops are all bad apples. They claim to believe in class and structure, but they act as if a class is merely a quorum of individually Good or Bad individuals with the Right or the Wrong ideas. They speak—and act, in an incessant effort to destroy particular individuals—as if changing structure simply means eliminating all the wrong kinds of people. It’s in the incessant effort to “keep the left weird”, as if it’s a subculture. But the workers of the world uniting will, by definition, not be a bunch of weirdos.
But the truth, of course, is that a material world structured around the distribution of wealth and power according to hierarchies will inevitably give rise to people who benefit from those hierarchies. It doesn’t surprise me that the rich exploit the poor and will do anything they can to protect their status. They’re only acting in their class interest. How could they do otherwise? The trouble isn’t with their souls, the trouble is with a world which will always replace any oligarch individually destroyed with a new individual oligarch. I don’t want to shoot the landlords, or punish them for being who they couldn’t really help but be. I just don’t want them to be landlords anymore. And really, it’s the same with these new “Marxists”. I don’t blame them for remaining fundamentally liberal and idealist in their outlook. They can hardly help it. That’s the kind of outlook, and the kind of person, that late capitalism is designed to produce. All I ever really want to say to them is that look, you don’t have to call yourself a Marxist. The word doesn’t grant you any special powers. You’re not a materialist. That’s fine. Do you. Be the hearts-and-minds Manichean warrior for the souls of the Good People that you want to be.
But in case anybody is inclined to listen, or in case you really are a Marxist, or a materialist, but you don’t believe a full revolution is around the corner, and you want to know what you can do to help the millions of insane people on the streets and in our jails, and figure, well, isn’t anti-stigma work a start?, let me suggest this: instead of begging sane people to be nice to us, to give us better doctors and free medicine, and compassion and dignity—always with the implicit threat that we better not fuck it up and perpetuate stigma through our actions—work to change the material world. Sane people won’t be nice to us until that world changes. So work to get us free medicine. Work for universal healthcare. Work for guaranteed employment, and housing, for the insane and for everyone. Quit NAMI and other respectability organizations and help found a radical organization, dedicated to organizing around a demand for the real material needs of the insane. Even easier: vote for Bernie Sanders for President, then get Medicare for All through Congress. Agitate for criminal justice reform, and an expansion of insanity pleas. The largest lunatic asylum in the United States shouldn’t be a prison in Los Angeles. If you want to be kind, and not use words like “crazy” in the meantime, fine. But that’s not going to change anything at all. Only one thing will, and it’s the only thing that ever has: radical politics, focused on structures, not people, and the reconstitution of production and society that comes with them.