In Mad World, Frazer-Carroll adopts a social model of mental health that opens the way to potentially transformative changes to current medical approaches, finds Lucette Davies

There is a growing awareness of the inadequacy of addressing mental health with our current medical model of psychiatry. However, this is doing little to assuage the escalating crisis in mental health that currently exists. Mad World: The Politics of Mental Health by Micha Frazer-Carroll carves out a radical new approach to mental health. More than that, it demonstrates how forging this new approach cannot be separated from tackling racism, gender or any other forms of discrimination. It is firmly anti-capitalist and anti-imperialist, promising to bring together a sense of solidarity between minorities to overthrow our current, highly toxic, political and economic system.

My interest in this book stems from the multitude of unanswered questions I still have about my own experiences of mental illness. Was I ill, or just judged because I was different? Am I ill now, or is it normal to be finding the social circumstances of my life distressing? How much can I reveal without being discriminated against? And how much can I hide while still being true to myself? How do we understand what mental health really means? And why, when so many people are affected by poor mental health, is so little happening to change the system?

Mad World does not offer an authoritative analysis of what mental health is. Or indeed how it can be addressed. Instead, it embraces the fact that mental health is diverse, deeply subjective, messy and at times confusing. It is a powerful argument that supports respect for the individual. I found it inspiring, hopeful and motivating.

I have for many years been an activist and campaigner, but I have always felt frustration with the lack of any meaningful fight for a solution to the crisis in mental health that engulfs so many communities. As Frazer-Carroll states: ‘Even in political spaces that are suspicious of state authority, deference to psychiatric ideas is very much the norm’ (p.86). Further, there ‘is a fear of getting the science wrong and a desire to outsource the tackling of mental illness to experts and institutions. I suspect this fear also stems from the deeply distressing, frustrating and demanding task of attempting to address mental illness in either ourselves or those around us.’

In her analysis, Frazer-Carroll offers a compelling and powerful argument to unite the struggles of every minority into one. Perhaps this book could be a trigger for even greater solidarity between activist movements and recognition that they all require the same changes?

Anti-capitalism

The book begins with a historical look at Britain’s asylums (Chapter 1) and the brutality of institutions such as the Bedlam hospital in London. She describes the passing of the Asylum Acts, which alongside the Poor Laws, offered a ‘way of managing poor, disabled and unruly bodyminds [the author rejects the separation of physical and mental health and so refers to complete ‘bodyminds’ throughout her book] that could not be easily exploited for profit’ (p.19). Many proponents of the social model of mental health will argue that, even today, people are labelled as mentally ill when they fail to be economically productive. The author points to the fact that in the fifth edition of the Diagnostic and Statistical Manual (DSM), work is mentioned 400 times (p.86). (The DSM is a US publication that lists every psychiatric diagnosis and the associated symptoms).

The chapter on asylums charts Britain’s changing approaches to mental health, including Thatcher’s program of mass psychiatric hospital closures in the 1980s. But as Frazer-Carroll points out Thatcher’s de-institutionalisation was not transformative and ‘we need to transform our material conditions on the outside too’ (p.29).

Chapter 4 discusses why work is making us sick. The author mentions Marx’s theory of alienation, which analyses the impact of workers’ separation from the product of their labour under capitalism. The author, in a later chapter, draws parallels with how mental-health patients experience a lack of autonomy when they need to suppress their feelings, and play by the rules to secure their release from hospital (p.157).

Although the brutality of some of the practices of Britain’s asylums has been consigned to the history books, modern-day psychiatry can be equally brutal albeit in different ways. The Mental Health Act allows for individuals to be detained without their consent, forcibly treated, physically restrained, and denied any choice in their day-to-day life. Patients can even be denied the right to engage in actions, such as taking a walk or listening to music, that they may find a comfort. But any display of anger, or protest by patients can be pathologised and treated as a ‘symptom’.

The arguments made in Mad World are firmly anti-capitalist. The book quotes cultural theorist Mark Fisher who noticed the link between neoliberal ideology and the changing face of psychiatry. Fisher examined how psychiatry labels individuals suffering from cultural and social stresses as having a chemical imbalance in their brain. He described this as ‘the privatization of stress’ (p.48). Indeed, this theory of chemical imbalances in the brain is extremely convenient to capitalism as it opens the doors to the manufacture and sale of pharmaceuticals.

However, Frazer-Carroll also pulls apart the idea that any alternative theories could offer a similarly authoritative statement on the true nature of mental health (p.49). She argues ‘that all [mental] illness is subjectively and socially experienced’ (p.50). The questions about my own mental health, which I had before reading this book, are all answered by this statement. I have realised that the answers all lie in how I am experiencing my life. Our emotions are not to be judged by others, yet we live in a society which can make us mad, label us as mad, and decide how to treat our madness.

Mad World also offers an analysis of the concept of diagnosis in Chapter 6. The author dissects the process of diagnosis, discussing both the benefits and pitfalls that these labels can have on an individual’s life. She argues against the existing divisions between knowledge of the professional expert and that of the person with lived experience. She further argues in favour of individuals being given the right to name their experiences in a way that feels appropriate for them. Acknowledging these ideas may sound unrealistically utopian, but she asks: ‘Would diagnosis matter so much in a society in which everyone could get what they needed, without requiring proof?’ (p.125).

The Trieste model

Mad World shines a spotlight on the strengths and failures of various theories behind mental health and movements to address it. However, the book does not end with the reader feeling there is no satisfactory answer to managing distress in society. Instead all the ambiguity is brought together to give an unequivocal answer. On p.162, the author asks the following question: ‘What transformation would occur if we centred harm reduction, de-escalation, compassion, and community, and tried every possible alternative we could think of before violating someone’s bodily autonomy?’

Far from suggesting an impossibly idealistic solution, the author finishes with an example of where that sort of approach is proving effective. Trieste in Northern Italy is recognised by the World Health Organisation as having one of the most advanced community healthcare systems in the world. They have no psychiatric hospitals. The author quotes Vincenzo Spaccapietra, who is a former user of Trieste’s mental-health services. He says: ‘The goal of the system is not just to get symptoms to improve, or remain under control in a scientifically efficient way: the goal is to help the person get better, and this can rarely be achieved with pre-packaged approaches’ (p.167).

The Trieste approach relies upon publicly funded, community-based healthcare without restraint or forced treatment. The system places the individual in complete control of his or her own care. Services are all voluntary, with no locked doors, and individuals can access the services without any need for a referral. It is not a perfect system, but it is one which is vastly better than anything happening in Britain today.

The author finishes the book by urging us to: ‘reject the capitalist and austerity mindset that demands a monolithic and limited approach to mental healthcare’ (p.178). She stresses that there may never be an answer, but we must respond to emotions as they change in a world that is also changing. She urges us to be brave enough to make mistakes and learn from them. Forging this radical approach will be a continuous process, but, as this book so eloquently demonstrates, there are many other minority groups who would benefit from us upending our current destructive system that lies at the root of so much suffering.

The final paragraph of the book needs to be heard by every campaigner, activist, minority group or individual who finds the system they live in troubling. It is one that has helped restore my faith that a better world is possible. Frazer Carroll finishes by saying:

‘The past and present of mental health has been dictated by capital, alienation, racism, colonialism, gendered oppression, psychiatric abuse, incarceration, gatekeeping and the enforcement of particular ways of knowing. The future must be something else. Although this project of liberation may never be finished, we should keep dreaming and imagining, out of our pain, into something we can really live for’ (p.182).

I hope I soon start to see activists forget their current deference to psychiatric medicine and embrace tackling mental health as part of their campaigning on many different issues.