A Marxist critique of psychiatry puts mental-health issues in the context of the social crises created by capitalism, and argues for socialist solutions, finds Adrian Cooley

As a psychologist, Rosenthal pays close attention to the role of mainstream psychology and psychiatry in our lives and in capitalism. While this is the predominant subject of the book, I think it’s better to think of the main subject of this book as about human health and its relationship with capitalism. Having said that, as with any Marxist perspective -which I believe this certainly is – to understand the true meaning of social phenomena, it is necessary to understand its relationship to the whole, so this book is about a lot more than just the topic of mental health.

Rosenthal asserts that the ‘illness model’ of psychological pain is essentially made up. Some may find this premise difficult to accept, but Rosenthal makes a convincing case and points out some very significant gaps in the mainstream model of ‘mental illness’ which she describes as ‘fraudulent’. Quite something coming from a clinical psychologist, however, she is certainly not the first. Many others have pointed this out; psychologist David Smail was a strong critic of mainstream psychology and psychiatry and even wrote what he describes as ‘not exactly a self-help book’ called: How To Survive Without Psychotherapy (2015).

Part I: a world of needless pain

The book starts with outlining how the predominant experience of the vast majority of people in capitalist society is one of psychological and physical suffering, and that the cause of that suffering is capitalism itself. Therefore, we must end capitalism, before it ends us, and we have to act now. This book can give you a view of the system and how it relates to suffering. It can act as a practical resource of facts and ideas to engage with people to build organisation and resistance against the system.

Rosenthal pays attention to the class structure of capitalist society, how this structure and the institutions and processes that underpin it cause mass suffering and why it operates like it does, i.e. in order for the ruling class to maintain control. It doesn’t take long to realise that Rosenthal’s analysis is firmly rooted in the Marxist tradition, and has many quotations through-out, such as the one below:

‘Accumulation of wealth at one pole [of society] is, therefore, at the same time accumulation of misery, agony of toil slavery, ignorance, brutality, mental degradation, at the opposite pole’(Karl Marx, Capital, vol.1, chapter 25, section 4)

The essential dynamics of capitalism is that at its heart, it is an exploitative system where workers are paid less than the value of what they produce, and that the capitalists take the rest as profit. It is a competitive system where the competitors are compelled to maximise their profits by increasing the days worked, removing skill from the job, busting unions, and pushing down wages and benefits. In short, higher profits lead to greater suffering. Exploitation can be measured in mental and physical distress.

Inequality is a key feature of capitalist society and Rosenthal provides mind-boggling statistics on the extent of inequality in society:

‘the more that capital accumulates, the more inequality grows, the more impoverished workers become, the more barren our cages and the greater our suffering. Capitalism is not a broken system, it is a system that breaks human beings’ (p.28).

Rosenthal dedicates a whole chapter to class war and talks about how the extent of social suffering depends on the balance of power between the contending classes. She proceeds to describe specific examples of strikes in history and the reforms they have won for the working class, particularly in the post-war years. Conversely, she writes about how the neoliberal offensive of the Thatcherite era reversed these reforms and put the working class into retreat. She describes the nature of neoliberalism, divide-and-conquer tactics, and how war is a key feature of capitalism.

Part II: concealing the cause of mass suffering

There are mechanisms that conceal how mass suffering is an inherent part of capitalism. This is achieved through the managerial class, the professional class, and even the trade-union bureaucracy, to control dissent and to promote the ideas of the ruling class. This acts to ‘bind workers and employers together in the social arrangement of capitalism.’ Without this middle layer, the working class and the ruling class would be directly in conflict, where the advantage would go to the working class with their larger numbers and ‘their hands on the wheels of production’.

Is ‘mental illness’ real as a biological problem distinct from social context? In this chapter, Rosenthal goes into more detail on how the medical model has been applied to psychological distress. It is an extremely interesting chapter. Rosenthal starts with quoting Engels, and I think it is worth requoting here: ‘The capitalists have made progress in the art of hiding the distress of the working-class.’

The medical approach dominates precisely because it conceals the social sources of suffering:

‘The longstanding biomedical tradition of medicalizing various forms of psycho-social distress and human suffering has cast a long shadow over the importance of addressing the social and underlying determinants of health’ (p.96).

Rosenthal dedicates a significant section of the book to eugenics and racism, how these ideas have manifested in policy and bourgeois thought historically, and how these ideas have influenced the modern development of the medical model.

Part III: containing rebellion

This is a really great section that begins with describing the origins of the concept of ‘normal’, i.e. the statistical theory of normal distribution where the measurement of occurrences of something in nature follows a bell-curve distribution:

‘The original meaning of the term was value free. Ruling classes define normal and “acceptable” as whatever serves them and “abnormal” and “unacceptable” as whatever challenges them. It is considered normal for police to kill unarmed people and abnormal for civilians to protest such killings. It is considered normal to blame immigrants for social problems and abnormal to blame the capitalist class. It is considered normal to be subordinate at work and abnormal to strike. It is considered normal to work all your life and make others rich and abnormal to question this arrangement. Any challenge to dominant beliefs is a challenge to the social order that requires them’ (p.143).

The economic tendency within capitalism to standardise has manifested itself not only in society’s approach to public health but also more broadly. Capitalists standardise behaviour in order to raise productivity and punish disobedience, with outliers labelled as deviant, disabled, and sick. This standardisation of work has been extended to the education system and resulted in the ‘factory school’ where kids who fall out of the normal distribution of expected behaviours are treated as requiring special needs. If you are a black child, you are three times more likely to be labelled ‘special needs’ than a white child.

Rosenthal then brings our attention to the state, its institutions and legal structures, the parliamentary system, the relationship between the state and unions, and state violence. She shows the role of psychiatry in the functioning of the state and its institutions, and the existence of psychiatric violence, and how they all come together and interact to contain rebellion against capitalism.

Part IV: the battle for freedom

In this final part, Rosenthal describes the Russian revolution of 1917, how it emancipated the Russian working class and how it inspired a massive international wave of working-class revolts across the world. She describes the context and forces that led to the ultimate defeat of the working-class nature of the revolution. She argues that its false portrayal by bourgeois historians is used to tell us that socialism is impossible and is associated with authoritarianism and state violence. The Russian Revolution demonstrated that a socialist transformation of society is possible but its defeat by the forces around Stalin, and the attempts to bury its achievements, have cast a long shadow of defeat, right into the present day.

The Cold War was portrayed as a political conflict when in fact it was a conflict between competing capitalist powers, with ‘Democracy’ on one side, and ‘Communism’ on the other. The measure of the success of this tremendous feat of propaganda can be summed up with the equivalence given between socialism and state capitalism, even in the minds of socialists, two vastly different things!

Rosenthal also covers the struggles of the working class in the post-war period and the various mechanisms and violence by the state that was unleashed against it. Then, in the chapter entitled: ‘We are in deep shit’, Rosenthal outlines the grave threats to humanity and the planet that climate change poses, and how the various forms of moralist arguments, such as individual responsibility for climate change, seek to prevent us from challenging capitalism directly. She outlines the problems with pacifism, anarchism, and identity politics. She points out how the various attempts at reform of the system and elements within it such as electoral reform, bourgeois feminism, and labour reformism have completely failed, and that the climate crisis is so grave there is no time left for ineffective solutions.

In the present day, the task of achieving real socialism is firmly back on the agenda, why it is important to know what real socialism really is, i.e. it is not state capitalism or the kinds of states we see in Cuba or Venezuela, for example. Rosenthal asserts how the working class is uniquely capable of achieving this task. She outlines the common kind of arguments against socialism such as what socialists call ‘the muck of ages’,e.g. the oppressive state, racism, sexism. Opponents of socialism will say these things are inevitable due to ‘human nature’. In the case of mental illness, they will emphasise its biological rather than social basis. Finally, there is the elitist belief that the working class are not capable of ruling themselves.

One of the key battles for the working class is overcoming divisions created by those acting to control us, and Rosenthal lays out a number of examples of how highly diverse workforces have come together in strikes and in struggles of the past; when such struggles erupt, the divisions quickly vanish. Many key revolutionary concepts are covered, such as the role of the revolutionary party, democratic centralism, the essential need to disarm the state and remove the capitalist class from power and replace it with a worker’s state. This is needed to uphold workers’ rule until the threat of counter-revolution has passed with the ultimate goal of abolishing class rule and achieving equality of worth of every single human being.

Conclusion

This book is valuable for the way it reveals a lot of the mystery surrounding mental and physical health and their relationship with capitalism from a Marxist perspective. The book helpfully draws upon socialist theory and condenses most of the key concepts and history, backed up with an online index of references, evidence, and even a forum to take the conversation further. She has a sharp, clear and concise style that is very accessible, bringing together a whole host of socialist ideas in a way that is very compact and easy to understand.

My only criticism would be that I think some sensitivity has to be exercised when criticising public-health-care provision, since psychologists and therapists are generally dedicated to their patients, and do a lot of good work, genuinely helping people. There is no doubt that many people get a lot of relief when diagnosed. For that reason, I think these arguments may result in a negative reaction in some. However, many professions within capitalist society are contradictory in this way. They are full of people who are dedicated to their work as a social good, but practice within a system that limits their effectiveness and distorts their impact, because of the requirements of capitalism. Education suffers from a similar kind of structural problem in this respect.

I think this book would appeal not only to those who have only recently become politically active, but also too seasoned socialists seeking new ways of presenting the impact of capitalism on human health.