If you’re the kind of oddball who fastidiously follows for-example links, you noticed that in my last entry, I used the late English essayist Mark Fisher as an example of a Marxist critic of mental-illness-as-medical-pathology who, I implied, was committed to the position that psychology, like almost everything, is a kind of superstructure: if bipolar disorder seems prevalent, then what we ought to be asking is whether or not that reflects the bipolarity of the market. As soon as I published that piece, I started to reproach myself for being unfair to Mark. His point, both in his extensive writing on mental illness, and even in the short excerpts quoted in the Jacobin review I linked, as far more complex than I made them out to be. I don’t think this was some immense smear—I wasn’t misrepresenting Fisher’s views so much as I was using one element of his take as an example of a larger tendency—but I want to give Mark his due, both because his actual point is worth considering at greater length, and because like almost every left wing writer to come of age in the last decade or so, I owe an enormous debt to Fisher, who really was and is irreplaceable, and whose work — particularly Capitalist Realism and Ghosts of My Life—changed my thinking and my life in ways very few other books have. You’ve heard this before. Mark Fisher has his detractors, but I’ve never encountered anybody who has read his work and wasn’t moved by it one way or the other.
So what was he actually saying about the relationship between capitalism and mental illness? A block quote from the Jacobin review I linked is a good start.
It would be facile to argue that every single case of depression can be attributed to economic and political causes; but it is equally facile to maintain — as the dominant approaches to depression do — that the roots of all depression must always lie either in individual brain chemistry or in early childhood experiences.
Meagan Day, the author of the review (and an excellent essayist in her own right), summarizes further:
One theme that runs through Fisher’s writing is the individualization and depoliticization of mental health. In an essay titled “October 6, 1979: Capitalism and Bipolar Disorder,” Fisher argues that the disintegration of security and solidarity under neoliberal capitalism has left people “psychologically trashed,” feeling abandoned and disoriented. Fisher, who himself struggled with depression, didn’t deny that mental illness has observable neurological manifestations. But he was aghast at the observable injunction against discussing the political and social conditions that permitted those neurological disorders to spiral out of control and destroy people’s lives.
“The current ruling ontology rules out any possibility of a socialcausation of mental illness,” he wrote. “The chemico-biologisation of mental illness is of course strictly commensurate with its de-politicisation.” If every individual’s mental illness is solely the result of anomalous brain chemistry, not induced or augmented by factors such as financial precarity or social isolation or neoliberal perfectionism, then we need not inquire whether our society itself is disordered.
Mark’s argument is—of course—correct. While some portion of mental illness can be attributed to genetic and biological factors (and this, I imagine, is particularly true in the case of more severe forms of mental illness), a good deal of it can also be explained by social and economic factors. Mainstream psychiatry even accounts for this fact: it’s one thing to be persistently depressed as a result of a chronic neurochemical abnormality; it’s another to be depressed as a result of one’s circumstances. A depressive episode in a bipolar patient and the deep depression of a person who has just lost a loved one may very well feel the same, it’s only that they don’t have the same cause. If Fisher is taking this argument further, he’s only taking it further by expanding (I think correctly) the range of circumstances which produce mental illness. You may be depressed because of a brain disorder. You may be depressed because your husband died. But you may also be depressed because the entire apparatus of western society has created the conditions for depression. A psychiatrist might not be eager to admit that final possibility, and part of that is (as Fisher says) because a good deal of mental-illness-as-individual-pathology has been weaponized to discourage us from conceiving of our unhappiness as a political problem, but part of it is also that it’s difficult to tell the difference between the two. A temporary depression with an obvious cause is easy to see. A lifelong depression brought on by economic factors and a lifelong depression brought on by a dopamine disorder are more difficult to distinguish. Both of them appear persistent, and immune to the influence of circumstances, except if you admit of everything about this life as a circumstance. Which of course it is.
The fact that identical illnesses can emerge from both idiosyncratic and environmental causes (or, obviously, a combination of the two, where the former is the risk factor, and the latter is the trigger) is clear enough when you think of physical illness. You might have a heart attack because you have a genetic heart disease. You may have a heart attack because you failed to maintain good health. You might have a heart attack because a nearby corporation has polluted your drinking water with a substance which does immense cardiac damage. You might have a heart attack because the material order you’re heir to isn’t designed to look out for your health; it’s designed to extract as much useful labor from you as possible while only paying you enough to afford shitty, addictive food, advertised to you at every opportunity. You may have a heart attack due to any combination of these factors. If the compatibility of these possibilities is more difficult to see in regard to mental illness, it’s only because we don’t understand mental illness very well. Our diagnostic and treatment protocols for depression are the equivalent of a medical universe where “coughing” was the disorder, subclassified by severity and perhaps a few proximal causes (did you just inhale a big cloud of ash?), but otherwise treated as a single unified problem. You’d have temporary coughing, major coughing disorder, maybe a relapsing and remitting cough, but we’d treat all of it with a cough drop prescription and breathing exercise. Don’t pay any mind to those smokestacks on the factory down the road.
All of this is to say that I don’t disagree with Mark at all. If there is any difference between us here, it’s only in who we imagine when we imagine our audience. This is an under-appreciated source of superficial disagreement among critics: what part of a complex issue you’re liable to emphasize depends a great deal on what you perceive as the already-accepted position you might want to complicate. Mark sees biological psychiatrist as the consensus; he wants to remind us that our environment is disordered too. I, perhaps to narrowly, see a generation of strivers eager to elevate what they already recognize as socially-induced depressions and anxieties to the level of an identity marker (the better for branding), and want to remind them that there are those of us whose illnesses are a difficult and complicated medical problem. But the underlying argument is the same: some people are more prone to psychiatric dysfunction than others, and late capitalism is not helping. It’s making the sick sicker, and infecting many of the otherwise healthy too.