Later On

A blog written for those whose interests more or less match mine.

Mental Health Is Political

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Dr. Danielle Carr, assistant professor at the Institute for Society and Genetics at U.C.L.A., writes in the NY Times:

What if the cure for our current mental health crisis is not more mental health care?

The mental health toll of the Covid-19 pandemic has been the subject of extensive commentary in the United States, much of it focused on the sharp increase in demand for mental health services now swamping the nation’s health care capacities. The resulting difficulty in accessing care has been invoked widely as justification for a variety of proposed solutions, such as the profit-driven growth of digital health and teletherapy start-ups and a new mental health plan that the Biden administration unveiled earlier this year.

But are we really in a mental health crisis? A crisis that affects mental health is not the same thing as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?

Some social scientists have a term — “reification” — for the process by which the effects of a political arrangement of power and resources start to seem like objective, inevitable facts about the world. Reification swaps out a political problem for a scientific or technical one; it’s how, for example, the effects of unregulated tech oligopolies become “social media addiction,” how climate catastrophe caused by corporate greed becomes a “heat wave” — and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become “inflation.” Examples are not scarce.

For people in power, the reification sleight of hand is very useful because it conveniently abracadabras questions like “Who caused this thing?” and “Who benefits?” out of sight. Instead, these symptoms of political struggle and social crisis begin to seem like problems with clear, objective technical solutions — problems best solved by trained experts. In medicine, examples of reification are so abundant that sociologists have a special term for it: “medicalization,” or the process by which something gets framed as primarily a medical problem. Medicalization shifts the terms in which we try to figure out what caused a problem, and what can be done to fix it. Often, it puts the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.

Once we begin to ask questions about medicalization, the entire framing of the mental health toll of the Covid crisis — an “epidemic” of mental illness, as various publications have called it, rather than a political crisis with medical effects — begins to seem inadequate.

Of course, nobody can deny that there has been an increase in mental and emotional distress. To take two of the most common diagnoses, a study published in 2021 in The Lancet estimated that the pandemic had caused an additional 53.2 million cases of major depressive disorder and 76.2 million cases of anxiety disorder globally.

Let’s think about this. The fact that incidences of psychological distress have increased in the face of objectively distressing circumstances is hardly surprising. As a coalition of 18 prominent mental health scholars wrote in a 2020 paper in The Lancet: “Predictions of a ‘tsunami’ of mental health problems as a consequence of [Covid] and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.”

Things get even less surprising when you look more closely at the data: If you bracket the (entirely predictable) spike in psychological distress among health care workers (a fact that itself only reinforces the idea that the major causal vectors in play here are structural), the most relevant predictors of mental health are indexes of economic security. Of course, it’s not simply a question of the numbers on your bank statement — although that is a major predictor of outcomes — but of whether you live in a society where the social fabric has been destroyed.

Before we go further, let me be clear about what I am not arguing. I am not arguing that mental illnesses are fake, or somehow nonbiological. Pointing out the medicalization of social and political problems does not mean denying that such problems produce real biological conditions; it means asking serious questions about what is causing those conditions. If someone is driving through a crowd, running people over, the smart move is not to declare an epidemic of people suffering from Got Run Over by a Car Syndrome and go searching for the underlying biological mechanism that must be causing it. You have to treat the very real suffering that is happening in the bodies of the people affected, obviously, but the key point is this: You’re going to have to stop the guy running over people with the car.

This principle is what some health researchers mean by the idea that there are social determinants of health — that effective long-term solutions for many medicalized problems require nonmedical — this is to say, political — means. We all readily acknowledge that for diseases like diabetes and hypertension — diseases with a very clear biological basis — an individual’s body is only part of the causal reality of the disease. Treating the root cause of the “epidemic” of diabetes effectively, for example, would happen at the level of serious infrastructural changes to the available diet and activity levels of a population, not by slinging medications or pouring funding into clinics that help people make better choices in supermarkets filled with unregulated, unhealthy food. You’ve got to stop the guy running over people with the car.

But if the public health consensus around diabetes has shifted somewhat in response to what we know, it’s been remarkably hard to achieve the same when it comes to mental health.

Psychiatric sciences have long acknowledged the fact that stress is causally implicated in an enormous range of mental disorders, referring to the “stress-diathesis model” of mental illness. That model incorporates the well-documented fact that chronic stressors (like poverty, political violence and discrimination) intensify the chance that an individual will develop a given diagnosis, from depression to schizophrenia.

The causal relationship may be even more direct. Remarkably, all throughout decades of research on mood disorders, scientists doing . . .

Continue reading.

Written by Leisureguy

25 September 2022 at 8:11 pm

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