<*- home: away from foundational challenges to modern SOMA

  Dialogue over the assumptions inherent in the statement "Capitalism individualizes mental health" with a leftist group

  I recently joined a leftist reading group - primarily comprising of students and academicians. They spent the month of October, 2020 perusing readings about capitalism's relationship to mental health. Some notable and popular authors included Dave Graeber,Mark fisher,Arlie Hochschild, Mikkel Krause.

  It concluded almost unanimously that it systemically individualizes it and puts the burden of responsibility of mental health and illness issues on individuals.

  I saw this exercise as a colossal failure. For the reasons I will describe here. 

  
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03 Nov 2020
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  The group agreed to discuss the following texts:
52. Chapter 6 and 7 of The Managed Heart by Arlie Hochschild
53. Emotion Work, Feeling Rules, and Social Structure by Arlie Hochschild
54. Chapter 3 and 4 of Bullshit Jobs: A Theory by David Graeber
55. Women mental health in India by Indira Sharma and Abhishek Pathak
56. Social Exclusion and Mental Health: The Unexplored Aftermath of Caste-based Discrimination and Violence by G C Pal
57. Good for nothing
58. Stop making sense by Paeder O'Grady
59. A Future with No Future: Depression, the Left, and the Politics of Mental Health by Mikkel Krause
60. How capitalism foments mental illness and discourages mental well-being
61. A history of drug advertising by Julie Donohue
62. Capitalism and mental health
63. A theory of mental health and monopoly capitalism
64. People Are Using ‘Pandemic Productivity’ as a Distraction From Grief, Vulnerability by Gretchen Walker
65. The Employment of people with mental illness by Geoffery Waghorn, Chris Lloyd
66. Disorder: Contemporary Fascism and the Crisis in Mental Health by Emma Dane York
67. The Impact of Decades of Political Violence on Palestinian Children in the Gaza Strip and the West Bank by Thabet
68. Identifying depression symptoms among general population
  living in conflict zone in Jammu and Kashmir by Anood Tariq Wani, Tafazzul Hyder Zaidi

  =====
  There was nothing particularly worthwile about the group's own contribution to these texts. The meeting involved the "ideological core" members describing their summaries of the texts and ending the meeting after fielding some questions. No knowledge that I know of was produced there. Nor were any of these texts examined critically - which I suppose is not hard to imagine considering that all of these texts are largely anti capitalistic and seem to confirm the general group belief in its ills (justified or not).


  The group concluded that capitalism has a tendency to individualize mental health and push the responsibility of dealing with it on the individual. Mark fisher's famous book "capitalist realism" is adored and accepted widely among leftists. However, this american brand of critique seems particularly impotent to me by definition. It poses questions that are cyclical or self contradictory. The following is an exchange I had on telegram in text with the members of said group, a few of whom decided to engage. Perhaps it will illustrate my concerns with the conceptualization of mental health by bourgeois indian students with the leisure available to them to read western authors and agree upon leftist criticisms that go nowhere. It also documents the resistence one is likely to encounter in attempting a critique of 'mental health'.

  The value in this discussion lies in revealing how mental health is typically framed. My thesis is provided in the first text.
  
<*- read something that isn't the amateurish political perspective of some 20somethings on an IM app

Text in black: Me
Text in any other color: someone else.


[Tsuki] Hello, Sorry if this is a bit late but I had some questions regarding last month's discussion on mental health. The primary one being; do we have a mutually agreed upon definition of mental health? More importantly, can we draw a boundary around this relatively new paradigm it to delineate what it is from what it is not, historically and culturally? It seems that everyone in the meeting seemed to intuit its fuzzier meaning and use it as an umbrella term to describe a wide variety of psychological disorders of the kind that one finds mentioned in books by primarily American left authors that are attempting to conceptualize their discontent through the psychoanalytic/freudian school (Freud, Meyer, Schneider) which now holds influence through a taxonomy of "disorders" [or non normative behaviors] the authority of which resides in organizations such as The American Psychiatric Association which publishes books like the DSM-1 -> DSM-5. Said books contain a catalogue of non-normativity which begs questions over what exactly is normative behavior and what qualifies as a mental illness or mental healthy? Quick note: the origins of DSM and such authorities on mental "Wellness" likely can be traced back to the necessity of state census: 1. To collect statistics on prevalence of "idiocy/insane": Terms that since then have been discredited (as surely our current usage will be too eventually) 2. which led to the qualification of large numbers of black people in NON-slaveholding states as mentally insane The necessity of census as stated in the american constitution is due to tax collection. ——— There are arguable benefits to accepting this paradigm - it perhaps provide a less crude language to the description of grief and suffering than existed before for a specific population. However, universal acceptance of a paradigm as a given without further contextualization has significant costs. Some of which touched upon in a couple of readings. But some not as much: 1. In post-tsunami Sri Lanka, Western trauma counselors who, in their rush to help, inadvertently trampled local expressions of grief, suffering, and healing - and introduced PTSD 2. The rise of american suburban versions of anorexia nervosa In Hong Kong in regions of higher western acculturation. 3. Multi-million dollar campaigns by one of the world's biggest drug companies to change the Japanese experience of depression—literally marketing the disease along with drugs like prozac and SSRIs. Those with access to american literature and pockets to afford psychotherapy might find it useful, but does a wage worker who doesn't speak english also conceptualize their discontent through "mental health"? or is it done in more specific, relatively unrecorded ways that range from religious expression to social behaviors of consumption (healthy or otherwise)? Is this terminology adequate for non european, non american , non-bourgeois-indian-student populations? ———- This brings me to another doubt. The primary question the meeting discussed was the "individualization of mental health" wherein we didn't quite arrive at a collective solution to how we could move away from this phenomenon. I posit (and this is my conjecture) that individualization of mental health is not a defect but a feature. That the experience of psychological suffering exhibits patterns that can be found in individuals but its conceptualization as an issue with one's mental health puts the onus by definition of what is mental on the individual's head and therefore gives rise to a biopolitics of treating said head with drug interventions by larger pharmaceutical companies pushing prozac or alternatively by psychotherapists pushing solutions such as meditation/cbt/etc. Perhaps an alternative exists in challenging this paradigm and politicizing distress in the form of "social health" where we point to relations among workers and their relation to institutions that sustain capitalism as the progenitors of such distress. A therapist might not suggest I throw a molotov cocktail through a bank window. Now will a psychiatrist. But a bio politics that examines the relationship between grief and hopeless mortgages and student loans will expose a social relationship between people instead of fetishizing biology and the mind. Perhaps this is going to be controversial since this paradigm has likely helped many. But many exist who have found this paradigm unsustainable for them. Where this stop gap solution of therapy/pshychiatry emerging fast due to atomization of workers and breakdown of conventional social structures has not been adequate. For such discontent, on the margins, maybe a paradigm overhaul is due.

[AZ] Responding to some of your points: 1. Normativity is equally varied when it comes to physical health - the spectrum of ill health, for example, could be as varied as having debilitating bronchitis to being out of breath too quickly every time you take the stairs. Similarly, being "healthy" could vary from someone who appears fat but can crush it at tennis, to someone who appears thinner but can't get through three reps of crunches. However, this variability is not used to dismiss the concept of physical health altogether - but just needs to be suggested that it can be contextualized. I suspect the reason we will not dismiss physical health that easily is because it is tangible and corporeal, and the mind is not. 2. I do think some universal ideas of mental health can emerge, in spite of cultural specificity. Wellbeing is hard to define, but ideas like resilience after setbacks/tragedies, capacity of individual to carry out tasks that s/he wishes to engage in, not harming self and / or other people - I'm not a psychologist but these are some things that I could think of. Of course, mental health will still have to be contextualized by culture, but some universal aspects can exist. 3. Do non Western non bourgeois people find the idea of mental health useful - not something I want to comment on. But a good model of mental health which is culturally contextual will accommodate their language for it and their ways of dealing with it. But also mental illnesses are real, dealing with them is distressing. And some cultural conceptions tend to demonize and stigmatize them, so we should be wary of reifying traditional historical ways of framing the issue as well. We should not also reject mental health entirely as a framing just because it comes from a Western context, because medication/therapy ARE required and ARE helpful in some cases. 4. On the individualization of mental health - we exist in social structures, but we are also individuals, and tend to think of ourselves as such. I don't see a conflict in engaging with individual impacts and engaging with broader social structures causing grief and distress. Also I believe many people tend to see mental health as catchall for or synonymous with anxiety and depression. There exists a lot more both in terms of illnesses and in terms of wellness

[Tsuki] There seems to be a larger concern that you foster about dismissal of mental health - understandably considering the emergence of the concept has coincided with the emergence of the view that it is neglected. There's no intent here to 'dismiss' it or underplay the importance of addressing grief, discontent, suffering. Their expression imo holds the key to criticizing modern life and subsequently giving rise to even the potential for revolutions that are sparked off with widespread discontent. However 1. Nobody here dismisses physical health, and nobody here intends to dismiss mental health either. The intent is have a clear definition of the paradigm under which it can operate and under which it can not. Without recognizing the latter, one runs the risk of homogenizing culturally specific experiences that are more social in nature into western perspectives that help some individuals but sustain larger ideology of individualism serving an atomized worker population. As for discussion of "the mind", I'm not sure of the usefulness of cartesian abstractions. The brain is corporeal. And distress can be behaviorally observed. I cannot speak much to non-material concepts. 2. I'm highly skeptical that universal notions can emerge from traditions as specific as the psychoanalytic one. As I've demonstrated using examples given above. It serves well for some populations but fails entirely in other. In fact I suspect the idea of a universal humanity does more harm through the reification of western perspectives and modes of thought as the natural, universal mode of life. Something that has happened throughout history in philosophical discourses of "what is civilized", "what is normal", "what is human" with devastating consequences 3. Agreed. But distress, grief, suffering, etc all exist and are often spoken of aculturally in generic forms. One can likely identify patterns in social maladaptation in which individuals are engaged in tangible struggles with emotion and thought, and the subsequent problems induced by them. Therapy /is/ useful and so is medication in some cases. But the discussion is grossly incomplete without - addressing the forms of authority and economics that have resulted in their widespread distribution - a historical outline of where they emerged from so that the possibility of an alternative can be envisioned (as opposed to the resignation one finds in american left authors) - their limitations delineated so that the paradigm is at least open to critical analysis and improvement from within that can give space for the politicization of such individualized discontent 4. Yes. We conceive of us all as individuals, less often as an aggregate of social relations with institutions and people around us. In light of that i guess the problem of why mental health is being "inidivdualized" by capitalism becomes somewhat obvious as a restatement of an ideology/paradigm which I'm attempting to look at historically here I would like to reiterate - the above discussion has /no/ intention to dismiss/trivialize/ignore/invalidate experiences with mental health for anyone. However, it is a call for discussion over the possible improvements and limitations of a paradigm that many have identified as requiring saving from individualization by capitalism. by others as being limited in non-western non-english speaking populations.

[AZ] 1. Re your point on the mind being certesian/not something we should or could account for: I think [SC] would be best placed to answer this. 2. The psychoanalytic tradition is *one* tradition even within the Western paradigm. Alternatives that focus on behaviorism exist. Also alternatives that draw on meaning making etc like logotherapy also exist. Saying that people need a certain range of emotional responses that are adaptive does not necessarily mean you are saying that universal western humanity exists. Even with psychology and psychiatry it is recognized that the individual's specific culture and context is important. 3. Largely agree. But also Anupam had pointed out that mental illnesses aren't just about distress, grief and suffering, in some extreme cases they are also capable of affecting agency, autonomy and decision making. With psychosis, for example, it gets even trickier - Western medicine isn't humane to people suffering from psychosis but many "traditional" responses - especially rooted in superstition - are worse or equally bad. 4. Obviously capitalism individualizes and atomizes us even more. But I'd argue that humans also have an innate need to conceive of themselves as individuals. And we need solutions that deal with us as individuals as much as with structural issues. But individual will never fully be resolved without the structural.

[Tsuki] 1. I made no normative statement over what "should" be accounted for. But stated that it's unclear to me how to speak of a non material cartesian abstraction. I'm not an authority on linguistics or psychiatry. But as a layman i find it easier to speak of observable tangible behaviors. 2. I mention the psychoanalytic tradition most often because a good number of the terms associated with practice of mental health in the form of psychotherapy and its increasing discussion in public use terms coined by academics in that tradition. I also am claiming that these measures of therapy are not exhaustive and have demonstrably been at odds with at least some culturally specific methods of coping with the varied, likely far more numerous forms of expressions of distress/discontent or the absence of agency, autonomy and decision making. 4. I reject this conjecture about an "innate need to conceive of themselves as individuals" because it is an essentialism for which I have no evidence. And i don't quite believe in platonic essentialisms pertaining to human behavior that aren't materially obvious - hunger/thirst/etc. I agree that we need stop gap solutions for individuals who don't find structural support. and I agree that therapy is definitely a useful one for many. But I'd qualify that by claiming that it by design is just that- an individual solution which ought not to surprise us as individualizing a problem and which has limitations that need to be discussed and historicized. And especially so in its relation to capitalist institutions that profit from it. which was the intent in this text - locating the original intent behind the DSM vocabulary that is now increasingly taken for granted but found its primary function in collating statistics about taxable populations, sanctioned by an american body holding the public authority over what was "idiotic/insane" in the 19th century and what qualifies as a "disorder" in the 21st. I wonder what all of our current terminology will appear as shockingly insensitive and offensive 80 years from now Also, I guess whether what state machinery will operate in granting licenses to a field of professionals that hold authority in the application of the term 'disorder'. Can one get licensed to practice as a therapist when one's psychosocial solution to dealing with discontent is advocate for lobbing molotovs through bank windows?

[AZ] 1. Again waiting for [SC] to respond on this, but essentially - mind and consciousness are complicated. Whether dualism is to be accepted is also complicated. (Sorry if I misunderstood the SciTech caucus discussion on this.) 2. Again, not disagreeing that models of therapy have to be adapted to cultural contexts that they may be at odds with, and that they are part of the solution, not the whole solution. That's what mental health month was largely about. But also, these things won't magically go away with socialism. 4. Agree with you insofar as as therapy's inadequacy is concerned. Let us agree to disagree on self-conception as individuals. But also licensed therapists with anti-capitalist and feminist perspectives exist.

[Tsuki] 1. I am wary of introducing philosophical abstractions because they result in interminable discussions over essentialisms and end up being unhelpful or tangential. The validity of dualism imo is irrelevant to the political questions i have or of the sort "what is to be done" As for licensed therapists being anti-capitalists - I find only the forms amenable to and incorporable within capitalism acquire any legitimization [as mark fisher would agree about nirvana, music, pop culture, or state approved discontent channels or anything now really]. That one can be as anticapitalist as one wants as long as it doesn't really pose any significant challenge to property rights or the state machinery and ideology supporting it

[SC] To @beguiledmoonchild's question The primary one being; do we have a mutually agreed upon definition of mental health? More importantly, can we draw a boundary around this relatively new paradigm it to delineate what it is from what it is not, historically and culturally? I agree that we kept emphasising the fuzzier meaning of mental health and the lack of a clear cut diagnosis, and very very importantly, emphasised how it indeed should be seen only in the cultural and social context the person is in (Fisher's work, Graeber's work, the pieces on people from the Valley and the Strip, the work on women's mental health in India, a bit of Fanon, a piece on the mental health of the Dalit people). I personally, as well as all the panel members had spoken about the DSM not being perfect by far, and how it keeps changing, and of course the diagnosis has a region/language/culture bias too.

[AZ] But psychology/ some forms of psychiatry CAN coexist with anti capitalist attitudes, and the whole point is to try and popularize those attitudes within the larger discipline. That is the point I am making - that though psychiatry and psychology have often been tied to state/capitalist power, they need not be. That while they do carry notions from a Western context, that does not mean they do not apply at ALL or need to be discarded uncritically.

[SC] To the question Those with access to american literature and pockets to afford psychotherapy might find it useful, but does a wage worker who doesn't speak english also conceptualize their discontent through "mental health"? I think that the point was to emphasise that no people don't, not even in America do workers who speak English and know about mental health, do, and the things in the readings are saying that, to quote Le Pitchfork Cosmonaut - At the very least, an array of mental issues, including depression and stress, anxiety and phobias, schizophrenia, eating disorders and dysmorphia, obsessions and compulsions, PTSD, psychosis, and ADHD, are hugely exacerbated by the society we live in, i.e. to recognise that people should expand what they understand "mental health" I majorly agree with this in the sense that there is a spectrum of physical health for sure too, new work about what constitutes pain is coming up as we speak. Also that it is 'easier' to see issues of physical health because it is tangible and not the mind, is not to say that the mind is non-material (of course it isn't, and has it's basis in matter), but that it is easier to literally see for someone else that I am sweating and grimacing in pain than to realise that inside I am dying because my job is causing me to be inexplicably bored, my family is sick, and the state is actively persecuting me, and I have a resting poker face. As for if we can have a universal paradigm of mental health, probably? Is there an international paradigm of what society should be - I think as part of a socialist reading circle, and socialism has to be linked with internationalism, I do expect and sincerely hope so. Again it shouldn't be a bulldozing factor, nor should it be centralised and dictated. Let me try to give an example. The fact that socio-economic-religious factors will interact with individual life experiences can be something everyone will agree on. And then on top of that, for a professional working in say, Bangladesh, you have someone trained in the history of post-war Bangladesh with the history of targeted violence, followed by being pushed into a mind-numbing garments industry, and they are treating someone who is again known to be individually having issues with interaction because of the language they speak. As for psychoanalytic tradition, as has been spoken here time and again as well, I doubt it is used in many forms of psychiatry, and for sure not in science in modern times at all because of the primacy of instinctive drives, unconscious, etc, and less of cognition. Universalising is not bulldozing into the same - something which the French colonial empire loved to do for example - whatever that same may be (and yes historically with colonialism, etc, it has always been the west), but accepting that there is a 'human experience' and society across the world with more in common than not. I do think I have a belief in that, as I said before, socialism without at least the hope of internationalism is meaningless to me. I think I answered partly 1. and 2. before. I do hope my pessimism triumphs over your skepticism 😆 For 3, I am glad you agree. And I do see that there are tendencies to generically talk of distress, grief, suffering, but that is exactly what we have been trying to de-emphasise. I agree that the writings we found were very American-oriented (couldn't find better ones for a popular audience, sadly ;_;) but surely your concerns are addressed by say, the reading of Aatina Nasir Malik which uses ethnography and the games played by children in the Valley to comment about them. [SC] Yeah with Tsuki on this one, I am not sure about the innate need to conceive as individuals. I am sure some do, maybe some don't? That's why a solution will deal with both, as you suggest later

[Tsuki] I don't think it is enough to call the DSM "far from perfect". That implies it is a universal work that can be brought closer to perfection or universal acceptance. Instead of addressing its original ideological function of distributing a taxonomy of "disorder" and non-normative behavior through an american institution that intends to help the state statistically account for taxable/non-taxable populations by virtue of their economic function. >>As for: "At the very least, an array of mental issues, including depression and stress, anxiety and phobias, schizophrenia, eating disorders and dysmorphia, obsessions and compulsions, PTSD, psychosis, and ADHD, are hugely exacerbated by the society we live in, i.e. to recognise that people should expand what they understand "mental health" that says nothing meaningful to me. Yes they're exacerbated by society, they're caused by it, and I'm going further in stating that they can be located very specifically within the apparatus that holds authority over diagnosing such phenomenon. [see the case of rising bulimia in hong kong and introduction of ptsd in sri lanka - sources cited]. That the call for expansion of mental health isn't necessarily the same for the call for a decentralized method of expression that permits people to discuss their distress/discontent in their own language publicly. I do not want to go to a rural village and tell someone they've got . Rather have them speak about their distress in a language that hasn't already been bulldozed over by an paradigm that is inherently individualizing [and about which people wonder why capitalism has individualized it]. Was "mental health" as it is typically discussed EVER a social phenomenon? Has any psychiatrist or therapist at any point advocated or prescribed property damage or revolutionary activity? I guess speaking from personal experience they're more likely to prescribe prozac and meditation - which is DEFINITELY A VALID PRAXIS TOO for the people it helps. But the question of why mental health is individualized by capitalism seems circular to me. Not to mention that is a subject of discussion among leftists, students familiar with occidental literature. But are there records detailing community support in local, non occidental regions where this paradigm hasn't arrived yet? And in the absence of any, are we ready to commit to this paradigm as universally useful for a politics that expressly intends to flesh out social relations and politicize seemingly private problems? I don't think I imply that it is universalist when I clearly say it is biased by region/language/culture. You are right in calling out its origins. Using the DSM is problematic. I also don't exactly get why there is a conflict when what I meant by expanding what people understand by "mental health" includes using a decentralised way of talking about it.

[SC] What do you think about the things that I have written here in the first paragraph?

[AZ] @beguiledmoonchild "I don't think it is enough to call the DSM "far from perfect". That implies it is a universal work that can be brought closer to perfection or universal acceptance. Instead of addressing its original ideological function of distributing a taxonomy of "disorder" and non-normative behavior through an american institution that intends to help the state statistically account for taxable/non-taxable populations by virtue of their economic function." There is also an ICD-10 which is more internationalized, if anyone here knows more about it, please do interject. I agree that the form that the DSM takes has an ideological underpinning. But if we are to accept mental health as at least partly a biological issue, we will need some form of medical document to address that part. And even if we look at common patterns of mental distress, some universal experience that can be tailored to context is useful. "that says nothing meaningful to me. Yes they're exacerbated by society, they're caused by it, and I'm going further in stating that they can be located very specifically within the apparatus that holds authority over diagnosing such phenomenon. [see the case of rising bulimia in hong kong and introduction of ptsd in sri lanka - sources cited]." Soft disagree here - I would see this in the Sri Lanka case as a misapplication of the diagnostic framework without regard to context rather than saying it should never have been applied. "That the call for expansion of mental health isn't necessarily the same for the call for a decentralized method of expression that permits people to discuss their distress/discontent in their own language publicly." Agreed, especially under capitalism, but also under socialism if we aren't careful. "I do not want to go to a rural village and tell someone they've got . Rather have them speak about their distress in a language that hasn't already been bulldozed over by an paradigm that is inherently individualizing [and about which people wonder why capitalism has individualized it]." No, ideally instead of telling them they have got (insert term), we listen to them in their language, see which definitions from our manual come closest, rigorously see how they may or may not depart from this person's situation, account for the history of the place and the person's social location, and help them find treatment options that on this basis with informed consent and keeping in mind their social context. Just because that is not how things happens in most cases does not mean they can never happen, and I know of a few psychiatrists who do use the DSM that way. "Was mental health EVER a social phenomenon?" No. But that does not mean it can never be. I'm not saying accept DSM or ICD uncritically, but do not reject them uncritically either simply because of their ideological origins. Things with ideologically murky origins can still be useful. Engage with them critically and with context.

[Tsuki] >As for if we can have a universal paradigm of mental health, probably? Is there an international paradigm of what society should be - I think as part of a socialist reading circle, and socialism has to be linked with internationalism, I do expect and sincerely hope so. I don't quite understand what you mean by "internationalism". I'm wary of universally homogenizing ideologies. I see value in socialism in its capacity to liberate workers confronting their immiseration, daily alienation and absence of freedom. More importantly as a system that is minimally necessary to guarantee effective political democratic participation. However, I can't possibly advocate for an "internationalist" all encompassing ideology that flattens culture/identity considering the 20th century has ample example of where that leads. As for the worker in bangladesh, I believe there's a vast difference in describing his issues as a function of war and crushing industry conditions as opposed to diagnosing him with a label borrowed from a book issued internationally the consequence to which is him getting a drug that neutralizes his capacity to confront the issue or see it as an issue in the first place.

[AZ] Also to use your village example, what if their language or response for someone who is neuro divergent or experiences psychosis is to label them, ostracise them or use some form of remedy that makes things worse? Because those things also happen. To sum up my position on the issue: mental illness is real, brain biology is real, yes it is very much exacerbated and partially caused by capitalism and social structures. But a biological component nevertheless remains in many cases. Psychiatry and psychology will be needed to treat those. Whether psychology and psychiatry are totalizing or context specific and sensitive is the question.

[Tsuki] I'll look at the ICD-10 but I'd be absolutely shocked if it includes a comprehensive and exhaustive centrally compiled account for expressions of discontent/distress/grief around the world. I'm willing to bet on it. I'm not sure of its history so I'll read more. "ideally instead of telling them they have got (insert term), we listen to them in their language, see which definitions from our manual come closest, rigorously see how they may or may not depart from this person's situation, account for the history of the place and the person's social location, and help them find treatment options that on this basis with informed consent and keeping in mind their social context. "Was mental health EVER a social phenomenon?" >No. But that does not mean it can never be." That requires strong ideological commitments to a individualism as a paradigm that can be coopted and reformed. And i suppose that is exactly what is happening now. The US has been the world leader in exporting mental health diagnoses and treatments and they are being adapted across cultures. This is happening. [Tsuki] I'd agree that modern working conditions and social problems cause vast populations of people to experience significant distress/alienation/grief/issues that have significant emotional consequences to those experiencing them - to the point one can require medical intervention to function socially (which addresses brain biology). The behavior observed that causes suffering is /not/ under question. It exists. Yes. How to address it socially is a political issue. Through an SSRI or a molotov. A praxis surely exists that accounts for both. Moreover, I think "Psychiatry and psychology will be needed to treat those." is a normative dictum that I find inherently ahistorical and frankly quite scary. I don't want the normalization of tranquilizing drugs as the only tool available to those who are being dispossessed of the capacity to conceptualize and express discontent without being grouped in a group that is pathologized and "treated". That being said, I agree that there definitely are social uses to medication to help people who're struggling as stop-gap solutions. [Tsuki] The politics of prescribing a psychiatric drug to a body for it to be taxable and employable as an individual (on the grounds of an authority's definition of its disorder) is different from being prescribed it temporarily to be able to go to a protest and ask for more fundamental/social changes that do away with the necessity of such drugs in the first place.

[NS] you are essentially saying here that if social conditions are perfectly nurturing, there will be no psychiatric issues requiring medical intervention?

[Tsuki] no. I am not saying this. at all.

[NS] "ask for more fundamental/social changes that do away with the necessity of such drugs in the first place."

[Tsuki] I am stating that if you agree with the premise that social conditions under capitalism cause psychiatric issues on a wider scale then you've already located the structural cause that requires addressing as a social problem. There likely will still be issues and the necessity for medical interventions. If capitalism causes such issues then perhaps conceptualizing said issues through an individualizing paradigm will not address the structural/social cause. It is definitely valid praxis. It helps people. But it is incompatible with the question of "how do we de-individualize mental health".

[AZ] Yes absolutely but you cannot ignore the individual's suffering. Also it is not 100% caused by social structures, there are lots of factors. There is a diathesis-stress model, which says that you are biologically prone (diathesis) to a particular condition, and a stress then provokes it to result in the mental health issue. As socialists, much of the stress for us is capitalism. But stresses outside of capitalism exist - abuse, loss, etc. Also neurodivergent people will also need recognition of their issues and accommodations. Those who are unable to function on account of their issues will need accommodations.

[Tsuki] Sure yeah. Agreed. The world is complex. I'm not one for universalizing a paradigm. I want multiplicity. Space for decentralized expression. Coexistence depending on context.

[AZ] Yes. But statements like "US is exporting mental health diagnoses" tend to undervalue the usefulness of one form of response to mental health issues.

[Tsuki] What is responsible is unclear to me. People everywhere desperately need stop gap solutions to be able to go to work. It's cruel and unethical to deny them whatever systems of support they have access to. But i honestly don't see them critically engaged with often enough. Or historically. Or politically.

[AZ] I agree that US norms have been used to construct many of the DSM 5. But people do happen to be neurodivergent in India too. And although DSM is imperfect, many have found some of its language as being able to give them a basis for making accommodations that they need.

[Tsuki] That is a literal fact. I am not assigning normative value on anything. I cited sources over the origin of the paradigm and its spread in non western countries

[NS] But there is a universality to being human that can be acknowledged and a broad frame whether written in English or other languages that offer a guide to diagnosis is in my opinion not to be dismissed just because of origins. [AZ] "That requires strong ideological commitments to a individualism as a paradigm that can be coopted and reformed. And i suppose that is exactly what is happening now. The US has been the world leader in exporting mental health diagnoses and treatments and they are being adapted across cultures. This is happening." You may be stating facts, correct. But the way you have employed them gives the impression that it is something you are condemning. So the fact that there is no normative value to your statement is incorrect.

[Tsuki] Can you point specifically to part that contains the normative condemnation?

[AZ] I wasn't speaking of a particular part, but the impression of what you said, placed in context. We do agree with you about the politics inherent in the framework. However, we also think the framework provides for some usefulness and should not be discarded merely because of those politics - rather it is adaptable to our purposes, but it should be critically engaged with. Which means chuck out the parts that do not help and keep the parts that do.

[Tsuki] Despite my reiterating explicitly that such medical intervention is often necessary and vital and valid praxis for people who don't have access to alternatives and desperately need stop gap solutions?

[AZ] Yes, because you still speak of the psychiatric and psychological framework that would be difficult to co-opt and reform because it is inherently individualizing. My contention is that even under socialism, individuals will suffer from some of these problems. So parts of the framework will have to be retained, after critically considering whether they work for the people or not. And many people who do not yet have access to the framework to articulate their issues would find it useful, just as many would find that it cannot describe their experiences. I think I have said everything I wanted to say.

[Tsuki] Not true. I did not claim they will be "difficult to co-opt and reform". In fact I stated that accepting this paradigm wholesale requires "commitment to individualism as a paradigm that can be coopted and reformed" and that this, in fact, IS happening. I did not claim any judgments on the difficulty/ease of this effort. I can't speak of what will happen under socialism. I only mentioned this because the dominant concern amid the group was that "capitalism is individualizing mental health" which seemed to me a cyclical ahistorical reading of the concept of mental health itself which embodies some inherent political commitments.