Library:Psychiatric Hegemony: A Marxist Theory of Mental Illness

Psychiatric Hegemony: A Marxist Theory of Mental Illness
Written in	2016

Preface

This book exists for two main reasons. First, to fill a gap in the current sociology of mental health scholarship. This omission was brought to my attention by my postgraduate students; though I was initially very sceptical of their research capabilities, it turned out that they were basically cor- rect. Granted, there are bits and pieces of Marxist analysis out there, but compared with the other mainstream areas of sociological investigation such as education, youth, crime, and the family, the use of the big man’s work to make sense of the continuing power of the mental health system is nearly non-existent. Second, this book offers a radical challenge to the conservative and theory-free scholarship which is currently infecting my area of sociology. I believe we need to bring critical scholarship back to the heart of the sociology of mental health; we desperately need to have the theoretical as well as the empirical debates.

The book title may suggest radical polemic, but at the same time, I think the argument is relatively simple and straightforward, and also, I think there is plenty of evidence to support it. Under capitalism, we live in a society of fundamental inequalities defined by our relation to the means of economic production. Public or private, every institution in capitalist society is framed by these same power disparities. The dominant understandings of who we are, what is expected of us, and the limits of our behaviour are constructed and defined by the capitalist class, then reproduced through the state and institutions of civil society (e.g., the systems of education, criminal justice, and health). This is necessary for the progression and survival of capitalism. For example, we are socialised by the family, the school, and the mass media to accept social and eco- nomic disparities as natural and common sense; as the inevitable result of differential talent and competition within the marketplace, rather than class privilege and the exploitation of the majority of the population. In this respect, the mental health system is no exception. Led by the insti- tution of psychiatry as the ultimate experts on the mind, mental health professionals are far from immune to the needs of capital. In fact, I will demonstrate in this book that the mental health system has been impres- sively compliant to the wishes of the ruling classes and, for that reason, has gained more power, authority, and professional jurisdiction as indus- trial society has developed. While this book is centrally a theoretical interrogation of psychiat- ric discourse and professional power, I have also attempted to make it accessible to practitioners and non-theoreticians. I think theory is vitally important to achieving a broader understanding of human existence within this world, but I appreciate that many put more faith in the “prac- tical solution,” in being “pragmatic,” and in changing the world through “doing.” I think mental health practitioners—and I have met plenty over the years—are particularly prone to this view. For this reason, there are four substantive chapters in the book (on the issues of work, youth, women, and political protest) which are written with the pragmatists in mind. These apply Marxist ideas to specific issues within the field and highlight the many dangers of simply “doing” mental health work with- out any thought to the wider structures in which they carry out such activities. Often performed by professionals who similarly believed that they were “acting in the best interests of the patient,” the history of psy- chiatry and its allies is littered with too many acts of violence, torture, and death to be able to write them off as aberrations or exceptions in a “progressive” and “scientific” system of health care. It can instead be seen as a regular service performed by the mental health system in support of the ruling elites.

What follows is my version of a Marxist theory of mental illness. It is only one contribution within the sociology of mental health, but nevertheless, I hope it inspires others to follow my analysis in equally challenging and critical directions. And if you want to continue the dis- cussion, you can email me at b.cohen@auckland.ac.nz or @BmzCohen on twitter.