Though capitalist societies are plagued by poor mental well-being, mental illness remains a highly contested concept, earning an ambiguous status. That poor mental health exists as something real is not in dispute here, yet there exists little consensus concerning its cause, with competing perspectives vying for dominance. This precarious understanding of mental illness has serious consequences for accurate diagnoses. A lack of clearly defined conceptualizations of mental health issues often acts as a significant barrier to developing an accurate understanding of the prevalence of mental illness. Ambiguity is further influenced by the fact that many mental health issues are not reported by those who experience them, being judged not as serious as physical health issues. Moreover, fear of stigma and discrimination if there is admittance of feeling mentally unwell persists. As such, a detailed understanding of the pervasiveness of mental illness under capitalism remains elusive, with the data reflecting varying conceptualizations, professional interpretations, and the willingness of individuals to report mental health problems.
The World Health Organization estimates that in 2021, globally, 1 in 8 people endured a mental health problem, with 301 million and 280 million experiencing anxiety and depressive disorders, respectively.1World Health Organisation, “Mental Disorders,” June 8, 2022. Mental illness constitutes a significant cause of the overall global burden of disease, with depression estimated to be the second leading cause of disability globally. Within advanced capitalist nations, the ubiquitous nature of mental illness is clear. In England, in 2021, an estimated 1 in 6 adults were experiencing a common mental health disorder, such as depression, anxiety, phobias, panic disorders, and obsessive-compulsive disorder in any given week. This was a 20 percent increase since 1993. Of all so-called common mental health disorders, generalized anxiety disorder and depression were the two most common.2Carl Baker and Esme Kirk-Wade, Mental Health Statistics: Prevalence, Services and Funding in England (London: House of Commons Library, 2023). In addition, the prevalence of suicidal thoughts and self-harm has increased, with 5.4 percent of individuals having suicidal thoughts and 6.4 percent having self-harmed at some point in their lives. This is an increase from 3.8 percent and 2.4 percent, respectively, since the turn of the century.
In the United States, in 2022, just under 20 percent of the population had a mental illness, with rates varying from 16.3 percent in New Jersey to 26.8 percent in Utah.3Mental Health America, “Prevalence Data 2022.” Since 2015, there has been an almost 2 percent increase in reported mental health issues in the United States, a rise from 42 to 50 million people. One estimate indicates that the United States has the highest number of individuals diagnosed with mental health issues compared to other similar wealthy nations.4Roosa Tikkanen, Katharine Fields, Reginald D. Williams II, and Melinda K. Abrams, “Mental Health Conditions and Substance Use: Comparing U.S. Needs and Treatment Capacity with Those in Other High-Income Countries,” Commonwealth Fund, May 21, 2020. Though mental health data has its many problems, the available evidence indicates that mental illness should be considered a significant health concern. Moreover, it is very reasonable to assume that the real rate of mental illness in such countries is greater than the data suggests, given how much of it goes undiagnosed and unreported.
Although anyone in society can develop a mental illness, not everyone has an equal chance of doing so. Patterns of mental illness predicated on social class, gender, race, ethnicity, and age, among other factors, illustrates that poor mental well-being is not equally distributed. Among all such determinants, social class and its intersection with forms of oppression and discrimination—such as racism, sexism, homophobia, and ablism, which shape our specific experiences of our own class position and exacerbate an individual’s unique experience of their own mental health—is arguably the most important. Accepting the relationship between social class and physical health is commonplace. Few would argue against the general idea that, on average, the health of individuals becomes progressively worse the further down on the income scale they are. Economic inequality exposes individuals to material conditions—such as housing, food, occupational conditions, educational opportunities, and environmental circumstances, among others—that are either positive or detrimental to one’s health, both physical and mental.5John W. Lynch, George Davey Smith, George A. Kaplan, and James S. House, “Income Inequality and Mortality: Importance to Health of Individual Income, Psychosocial Environment, or Material Conditions,” British Medical Journal 320 (2000): 1200–04.
Within this understanding of class as a significant determinant of mental illness, the purpose of this essay is to present a schematic illustration of a basic Marxist understanding of mental illness. Capitalism in all its facets is the single biggest determinant of mental well-being. Mental illness arises from a dialectical process—it is a truly materialist phenomenon, evolving from the interaction between the materiality of the human body, its inherent needs and desires, and the materiality of capitalist society.
Biological Explanations of Mental Illness
Under capitalism, biological explanations of mental illness prevail, permeating professional understandings. The acceptance of mental illness as originating from the biological dysfunction of the body dates back centuries. Yet, the biomedical model that dominates in its current form largely originated in the 1970s, supporting the growth of biological psychiatry that has since come to have hegemonic authority. In the immediate postwar era, it became increasingly apparent to those within and outside psychiatry that methods of diagnosing mental illness lacked reliability and validity.6Robert Whitaker, “Psychiatry Under the Influence,” in The Sedated Society: The Causes and Harms of Our Psychiatric Drug Epidemic, ed. James Davies (Basingstoke: Palgrave Macmillan, 2017), 165. Increasing criticism during the 1960s and ’70s came from the anti-psychiatry movement, under whose broad label Erving Goffman, R. D. Laing, David Rosenhan, Thomas Szas, Thomas Scheff, and David Cooper, among others, were highly critical of society’s treatment of individuals with mental health issues and how mental illness was understood. Their assertions seriously challenged the legitimacy of psychiatry. For many critics, psychiatry was little more than an agent of social control, as exemplified by the content and use of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
First published in 1952, the DSM quickly came to dominate the profession, monopolizing how mental illness was understood and acting as the source of reference for psychiatrists to make sense of, and label, their observations. Notwithstanding its professional popularity, it has never been short of critics. For much of its history, permeating the pages of the DSM has been a subtle, and at times less than subtle, moral and ideological agenda. Infamously, homosexuality was identified as a sociopathic disorder in its first publication, to be removed in 1974. Moreover, in 1980, with the publication of the DSM III, perceived uncertainties over one’s gender identity were included as a disorder. Additionally, the DSM has been a vital source drawn upon to justify the historic overrepresentation and diagnosis of individuals from ethnic and racial minority backgrounds. The reprehensible history of the DSM’s efforts to codify in “science” a knowledge base that both directly and indirectly has had the consequence of controlling the actions of certain social groups has led individuals, such as Bonnie Burstow, to identify the DSM as promoting a knowledge base that corresponds with eugenic principles.7Bonnie Burstow, “Psychiatric Eugenics Then and Now—You Betcha It’s Still Happening,” Mad in America, July 31, 2019.
In response to a sustained attack on the profession in the immediate decades of the post-war era, the 1970s witnessed psychiatry reassert itself and adopt an overtly biological paradigm. As Anne Harrington argues, by the end of the decade efforts to revise the core foundations on which psychiatry was built included claims that the profession was a branch of medicine that should use scientific knowledge and methods to identify the biological and chemical causes of mental illness.8Anne Harrington, Mind Fixers: Psychiatry’s Troubles Search for the Biology of Mental Illness (New York: W.W. Norton & Company, 2019), 128. Emphasis was placed on diagnosing mental illness based on observable symptoms, with an understanding that symptoms had a biological basis even if the biological cause could not be observed or identified. This paradigm shift was codified with the publication in 1980 of DSM III, which Edward Shorter described as “an event of capital importance,” as it constituted a “redirection…towards a scientific course.”9Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: Wiley, 1998), 302.
A biological conception of mental illness asserts that it is rooted in individuals’ genetics and biochemistry, and therefore that prominent mental health problems such as depression, anxiety, and schizophrenia emerge from certain organic compositions of the body. Reflecting biomedical values, influential interventions have been predicated on medical principles, and thus drugs have been seen as the only method to rectify these etiological causes. Epitomizing this is the chemical imbalance theory of the brain, an idea that has gained widespread acceptance among professionals for more than the three decades. Varying levels of neurotransmitters in the brain, such a dopamine, serotonin, and noradrenaline are said to influence the development of mental health issues, including, among others, depression, anxiety, and schizophrenia. Championing the disease model of mental illness, mental health professionals have been at the forefront of this framework. Said to be underpinned by scientific knowledge, professionals have embraced a biomedical agenda to assert their professional status.10Whitaker, “Psychiatry Under the Influence.”
The disease model of mental illness has dominated psychiatric understandings in the late twentieth century and early twenty-first century. Yet, despite its prominence, little evidence exists to support the premise that biology is the primary cause of the development of mental illness. No scientific discoveries during the 1970s justified this initial paradigm shift and the evidence for it remains sparse.11Whitaker, “Psychiatry Under the Influence,” 167. “None of the situations we call mental disorders,” Joanne Moncrieff asserts, ”have been convincingly shown to arise from a biological disease.”12Joanne Moncrieff, “The Political Economy of the Mental Health System: A Marxist Analysis,” Frontiers in Sociology (January 2022). Genome research has failed to provide conclusive evidence of any genetic underpinning to mental illness, and very little substantive research supports biochemical assertions that neurotransmitters are influential. Moreover, the effectiveness of psychiatric drugs can easily be questioned. The recent history of psychiatric and medical research into the efficacy of medication is littered with examples of the selective presentation and publication of positive results and the strenuous effort to hide negative data.13Whitaker, “Psychiatry Under the Influence,” 176–81. Despite the claims of professionals, the biological basis of mental illness must be considered, at best, speculative and, at worse, deeply harmful to people and society.14James Davies, Sedated: How Modern Capitalism Created our Mental Health Crisis (London: Atlantic Publishers, 2021).
Mental illness is profoundly a materialistic phenomenon, greatly determined by the interaction between the material conditions of society and corresponding economic organization, and the position of an individual within society.
As Marxists, our understanding of mental illness must oppose the disease model of mental illness—while not rejecting the possibility of biological causes in specific individual cases—and instead focus on contextualizing the development of poor mental well-being within society. Mental illness is profoundly a materialistic phenomenon, greatly determined by the interaction between the material conditions of society and corresponding economic organization, and the position of an individual within society. A social understanding of mental health is required, like that of the social model of disability. During the 1970s, British socialist and Marxist-inspired disability activists, such as the Union of the Physically Impaired Against Segregation, rejected biological interpretations of disability and strenuously advocated the understanding of disability as a social identity conferred on individuals, reflecting their oppression and exploitation. While potentially experiencing a physical or cognitive impairment, this was not the same as disability as a social category, which reflected their social status of exploitation and oppression as a consequence of capitalist society being organized and operating in a way to exclude individuals with certain impairments. Capitalism thus created disability, especially through its exclusion of individuals with impairments from the labor force.15David Matthews, “Disability and Welfare Under Monopoly Capitalism,” Monthly Review 72, no. 8 (2021).
Mental Illness and Economic Growth
The prevalence of the explanation of mental illness as a biological phenomenon also mirrors neoliberal values, particularly that of individualism and the dominance of the self. Not only that, but acceptance of biology as the root cause of mental illness offered a very lucrative basis for the expansion of commercial medical and pharmacological enterprises.
Capitalism, Karl Marx asserted, could be defined by its inherent need for economic expansion. “Accumulate, accumulate! That is Moses and the prophets,” he proclaimed. To remain competitively viable, all capitalist enterprises must continually expand, increasing their financial returns after investment. Yet, since the decline of the postwar boom, advanced capitalism has been characterized by stagnation, as reflected by the economies of North America, Western Europe, Australia, New Zealand, and Japan. Opportunities for investment are less than the quantity of investment capital available. Investment subsequently declines and existing output, produced from previous rounds of investment, is underutilized, resulting in the growth of surplus capital, goods, and productive capacity, including labor. The existence of surplus limits the incentive for new investment, as the potential to identify demand for future output is considered restricted if what has already been produced has not been absorbed by the market. Within this context, the recent history of advanced capitalism has been one of gradual stagnation, with capitalist enterprises engaged in an urgent quest for new outlets for investment. In this context, commercial medical operations have worked over the last four decades to identify a key new means of accumulation.16Joel Lexchin, “The Pharmaceutical Industry in the Context of Contemporary Capitalism,” in Health Care under the Knife: Moving Beyond Capitalism for our Health, ed. Howard Waitzkin (New York: Monthly Review Press, 2018).
As a method of stimulating economic growth, the disease model of mental illness has been very attractive, given its role in expanding the pharmaceutical market since the 1970s. As such, the industry has actively encouraged its own development and solidification. The last four decades have witnessed the pharmaceutical industry invest in the development not only of new products but, importantly, in a knowledge base that supports the disease model. It has been significantly involved in conducting research and financing, managing, and analyzing drug trials, including withholding negative results, as part of wider efforts to create favorable data. Additionally, the industry has influenced how its products are presented, employing industry individuals to write positive reviews and encouraging academics, often using financial incentives, to put their name to this work.17Lexchin, “The Pharmaceutical Industry in the Context of Contemporary Capitalism.” In this vein, the pharmaceutical industry has even supported the expansion of many academic departments. Overall, as James Davies proclaims, in the last forty years pharmaceutical corporations have been able “to literally create an evidence base…to legitimize their products.”
In addition to such efforts, the pharmaceutical industry has expanded its markets by broadening the medical basis on which mental illness is evaluated. In coalition with psychiatry, the industry has occupied a powerful position by being able to define “normality,” exponentially shrinking what constitutes “normal.” During the past forty years, more and more cognitive and subjective experiences have been reconceptualized as opportunities for medical intervention. As an increasingly narrower definition of “normal” has prevailed, there has been a reliance on drugs to return an individual to a perceived state of normality. Rather than reflecting the growth of objectively existing mental health issues, medicalization reflects the manipulation of knowledge for the purpose of economic growth. The direct link between the pharmaceutical industry and the expansion of the disease model significantly reflects the industry’s role in commodifying subjectivity, identifying experiences of the psyche as opportunities for accumulation and attaching value to them.
Not all scientific inquiry reflects the needs of capital, but capitalism does provide a framework within which scientific knowledge is pursued, influencing the construction of scientific knowledge. As Stephen Jay Gould asserted, there exists the significant possibility, conscious or unconscious, of a ruling class bias embedded in scientific investigations for the purpose of social control. The disease model exemplifies many of the ways capitalism infuses science, using it for both ideological purposes and commodity production.18Richard York and Brett Clark, The Science and Humanism of Stephen Jay Gould (New York: Monthly Review Press, 2011), 114. As Richard Lewontin has argued, science is “directed by those forces in the world that have control over money…as a consequence the dominant social and economic forces in society determine to a large extent what science does and how it does it.”19Richard C. Lewontin, Biology as Ideology: The Doctrine of DNA (New York: Harper Perennial, 1992).
Individualizing Mental Illness
A significant consequence of the medical science framework of understanding mental health is the construction of mental illness as an individual issue. Biology’s dominance reflects neoliberalism’s concern with the self, with both causes of and solutions to mental illness centering around the individual. The rise in popularity of cognitive behavior therapy—the principles of which are to modify how individuals think about issues in order to change their behavior—in this century can be seen as another illustration of the individualization of mental illness. The ideological consequence, as Joanna Moncrieff argues, is that “locating the source of problems in individual biology—blaming the brain—impedes exploration of social and political issues.”20Joanna Moncrieff, “Psychiatric Drug Promotion and the Politics of Neoliberalism,” British Journal of Psychiatry (2006): 188, 301–2.
Diagnoses and explorations of the cause of mental illness under capitalism start and end with the individual who needs correction to integrate into society. It is viewed in medical terms, with the cause located in the biological and chemical composition of the individual, and as such is something that individuals and wider society have little control over. This obscures the significance of social and economic factors in the experience of mental health and distribution of mental illness. The disease model and the process of medicalization privatize social problems when, in fact, radical social and economic changes is what is needed to alleviate and prevent distress. Capitalism and its values must be understood as integral to determining the development and nature of mental health.
The Misery of Capitalist Life
Instead of reducing mental health solely to biology, attention must be given to the social and economic determinants of mental illness. Capitalism, and the conditions of oppression and exploitation inherent to it, are the biggest determinants of mental illness. Throughout the works of Marx and Frederick Engels, sporadic reference is made to matters commonly understood today as mental health issues. Marx made a vital contribution with his concept of alienation, yet it was Engels who focused on the relationship between everyday capitalist society and its impact for mental well-being. Living under conditions of severe exploitation, oppression, and poverty, Engels argued, brings a pervasive desperate misery to working-class life. For large swaths of the labor force, life oscillated dramatically between fear and hope, constantly facing economic insecurity, which denied them contentment and stability, and resulted in the inability “to attain peace of mind and quiet enjoyment of life.”21Frederick Engels, The Condition of the Working Class in England (Oxford: Oxford University Press, 2009), 108–9.
For Engels, unemployment and destitution was always one accident, or death, away, while the whims of a laissez-faire system determined whether an individual would be able to eat an evening meal or left to the precariousness of the market, without protection or assurances. Conditions of acute uncertainty of existence had dramatic consequences for the mental state of many working-class people. Indeed, the extent to which the impermanence and misery of life blighted mental well-being was such that Engels noted how suicide had “become fashionable among the English workers, and numbers of the poor kill themselves to avoid the misery from which they see no other means of escape.” Alcohol abuse, which today is considered a mental health issue, was also common. Drunkenness, as Engels referred to it, remained one of the few sources of enjoyment available to the working class, many of whom indulged excessively to obscure the misery of existence. Such behavior, Engels emphatically argued, was directly the result of an exploitative existence: “They who have degraded the working man to a mere object have the responsibility to bear.”22Engels, The Condition of the Working Class in England, 114, 127.
Overall, Engels presents a picture of a working class riddled with despair, anxiety, and hopelessness. The uncertainty of economic life, not knowing if, and for how long, they would have a job or if they would be able to feed themselves and their family, placed a severe mental strain on many. In response, many working-class people sought sensory pleasures, as they were the few sources of pleasure available to them.23Engels, The Condition of the Working Class in England, 139.
Marxist Psychology and Mental Health
The analysis presented by Engels provides an essential basis on which to build a Marxist understanding of mental health, situating the emergence of poor mental well-being within the framework of capitalism and the social relations of exploitation and oppression. Though we must reject biological determinism, biology does influence mental health. But biology does not operate in isolation from social context. Mental health under capitalism evolves from a dialectical relationship between, on the one hand, the material conditions of capitalism and, on the other hand, the corporeal, and hence material, nature of the individual. Mental health is the product of continuous interaction between broader society and biological and psychological wants, needs, instincts, and desires, which have an intrinsic corporeal existence. Although Marx did not formulate a coherent psychological theory, and despite efforts to impose on him a kind of psychological relativism, he nonetheless contended that “we must first deal with human nature in general and then with human nature as modified in each historical epoch.”24Karl Marx, Capital, vol. 1 (London: Lawrence and Wishart, 1977), 571. Marx was acutely aware of certain elements as innate to the human experience: drives and needs, such as hunger and sex, on the one hand, and what Erich Fromm referred to as “passions” on the other, such as an individual’s need to express creativity and demonstrate and experience relatedness to others and nature.25Erich Fromm, The Crisis of Psychoanalysis: Essays on Freud, Marx and Social Psychology (London: Jonathan Cape, 1971), 65. For Marx, human nature had dual qualities, ones that are definitive and grounded in the corporeal existence of individuals, and ones that are the product of social existence. Together, they make up a truly materialist understanding of mental health.
As Marxist psychoanalyst Otto Fenichel wrote, “A materialistic psychology acknowledges the existence of the psychic as a particular realm of nature.” It “explains the special forms in which the psychic appears as derived from the material reality in which the bearer of this psyche exists (his body as well as the concrete environment which affect him by their stimulations).”26Otto Fenichel, “Psychoanalysis as the Nucleus of a Future Dialectical—Materialistic Psychology,” American Imago 24, no. 4 (1967): 292.
Capitalism and the Social Character
Marxist-inspired psychoanalysts like Erich Fromm and Wilhelm Reich contended that individuals are characterized by physiological, and for Fromm in his later works, psychological, instincts and internal drives intrinsic to humans. For Fromm, it was indefensible to assume that “man’s mental constitution is a blank piece of paper, on which society and culture write their text, and which has no intrinsic quality of its own.… The real problem is to infer the core common to the whole human race from the innumerable manifestations of human nature.” Early in his career, Fromm recognized the importance of biological instincts such as hunger, sleep, and sexual desires that required satisfaction “rooted in the inner chemistry of the body.”27Erich Fromm, The Sane Society (London: Routledge, 2002), 18, 65; Erich Fromm, Beyond the Chains of Illusion: My Encounter with Freud and Marx (London: Continuum, 2009), 27. He accepted the primacy of libidinal instincts as a fundamental biological impulse yet contended that, as humans evolved and their biological needs could be more easily met, the evolutionary process developed humans’ more complex intellectual and emotional capacities. As Fromm argued, humans “have their own basic needs, which they share with all the human race; they need to relate to others; they need to feel rooted in a world they consider their own; they need to transcend their feelings to be a creature either by creating or by destroying; they must have their own sense of identity that allows them to say ‘I’ and to have a frame of orientation that gives some meaning to the world they live in.”28Erich Fromm, “The Influence of Social Factors in Child Development,” marxists.org, 1958. Thus, many of the most significant human drives and instincts go beyond biology.29Fromm, The Sane Society, 27. In a similar vein, Reich emphatically emphasized the centrality of the libido and sexual instincts as paramount, even governing the nature of all individuals.30Wilhelm Reich, Character Analysis, 3rd edition (New York: Farrar, Straus, and Giroux, 1972).
Social systems greatly determine how instinctual needs and drives are fulfilled and the direction in which instinctual energy is channeled. Both Fromm and Reich posited that individuals must adapt their needs and instincts to society, and that most needs have a degree of plasticity that allow for this. This is what makes individuals capable of existing under, and within, various social conditions, as history illustrates. As Fromm underscored, “while the instinctual drives do develop on the basis of biologically determined instincts, their quantity and content are greatly affected by the individual’s socioeconomic situation or class.”31Fromm, The Crisis of Psychoanalysis, 155. And Reich argued that ”social conditions must first have impinged upon and changed human needs before these transformed drives and needs could begin to have an effect on historical factors.”32Reich, Character Analysis, xxii. Herbert Marcuse asserted this too, writing that “the reality which shapes the instincts as well as their needs and satisfaction is a socio-historical world.”33Herbert Marcuse, Eros and Civilization: A Philosophical Inquiry into Freud (Abingdon: Routledge, 1998), 14.
One consequence of the instinctual adaptation to capitalism is the emergence of what we can call a character structure, broadly shared by many individuals within society. The character structure reflects the sociohistorical ways in which the instincts of most people in society have been shaped, fulfilled, and adapted to the needs of capitalism at the time they are living. For Fromm, “every society has a libidinal structure,” a result of “the influence of socio-economic conditions on human drives.”34Fromm, The Crisis of Psychoanalysis, 161. Later in his life, Fromm referred to this as the social character: the ”essential nucleus…of most members of a group which has developed as the result of the basic experiences and mode of life common to that group.”35Erich Fromm, The Fear of Freedom (London: Routledge, 2001), 239. The social character reflects the broad similarities among members of society, in terms of attitudes and behavior—that is, “the sum total of character traits to be found in the majority of people in a given culture.”36Fromm, Beyond the Chains of Illusion, 62.
The purpose of the social character is to “mold and channel human energy within a given society for the purpose of the continued functioning of this society.” Without ignoring the multitude of unique individual characteristics, many people, Fromm argued, share a broad range of behavioral traits required and encouraged by capitalism for its preservation and reproduction.37Fromm, The Sane Society, 106–7. Similarly, Reich asserted that “every social order creates those character forms which it needs for its preservation…the formation of a psychic structure which corresponds to the existing social order.” For Reich, the shared character structure reflected the social relations of production, with the instinctual drives of the majority having to adapt to capitalism.38Reich, Character Analysis, xxii–xxiii
For Marx, human nature had dual qualities, ones that are definitive and grounded in the corporeal existence of individuals, and ones that are the product of social existence. Together, they make up a truly materialist understanding of mental health.
Though they placed emphasis on different aspects of what they perceived to be integral to human nature, both thinkers agreed that the fulfillment of people’s instincts and needs is essential to the development of positive mental health. As Fromm contended through his concept of normative humanism, “mental health is achieved if man develops into full maturity according to the characteristics and laws of human nature. Mental illness consists in the failure of such development.” For Reich, “libido stasis…is of course the specific energy source of the neurosis.” Meaningful sexual gratification was, Reich proclaimed, essential to alleviating and preventing poor mental well-being. Though instincts and needs can be modified, there are limitations to these modifications. Moreover, though needs can be satisfied in varying ways, it is the capitalist system that dictates how and to what extent. As Fromm explained, “if one of the basic necessities has found no fulfillment, insanity is the result; if it is satisfied but in an unsatisfactory way…neurosis is the consequence.”39Fromm, The Sane Society, 14, 66; Reich, Character Analysis, 14–15.
For Fromm, the social character that prevails under capitalism is contrary to the development of optimal mental health. Poor mental well-being and mental illness arise from this contradiction. As such, the degradation of mental well-being becomes normalized and becomes, as Fromm argued, a socially patterned defect.40Fromm, The Sane Society, 15.
Labor and Discontent
As Engels detailed, one of the biggest factors of capitalist society that contributes to mental illness, and is central to the wider misery of many, is labor. Low wages, poverty, and the precariousness of the labor market continue to have negative consequences on mental health. As epidemiologist Michael Marmot argues, insecurity, such as short-term employment and work with no fixed hours, can have severe consequences, including anxiety “disorders.”41Michael Marmot, Jessica Allen, Tammy Boyce, Peter Goldblatt, and Joanna Morrison, Health Equity in England: The Marmot Review 10 Years On (London: Institute of Health Equity, 2020), 65. For many, mental health deteriorates as a consequence of work failing to be meaningful; being forced into competition with others, such as for employment and resources; and using others in an instrumental fashion to advance their own careers. Work fails to fulfill the need to genuinely experience creativity, develop a sense of identity, and establish meaningful relationships, as many under capitalism feel little or no connection to their work and do not recognize themselves in it.
For Marx, as he wrote in the Economic and Philosophic Manuscripts of 1844, work should allow individuals to be freely expressive, both physically and intellectually, as a meaningful expression of inner creativity. Yet, under capital, labor is an alienating experience. For most, it is just a means of survival, often felt to be a monotonous and grueling obligation. Rather than being directed toward creative or communal endeavors, the passions and energies of working people are instead consumed by practices defined as useful only by the standards of capitalism.
Intensity of exploitation is a common determinant of mental illness. In Britain, for example, the last two decades has seen an increase in recorded rates of work-related stress, anxiety, and depression, with mental illness constituting 50 percent of all work-related ill health. Common causes included tight deadlines, too much responsibility, and a lack of support. Similarly, in the United States, 71 percent of all employees typically feel stressed or tense during the working day. Common reasons include poor wages, long working hours, and little opportunity for career advancement.42American Psychological Association, “The American Workforce Faces Compounding Pressure: APA’s 2021 Work and Well-being Survey Results.”
Working-class people in many advanced capitalist nations are blighted by an intense mental malaise, characterized by regular feelings of dissatisfaction and boredom. In 2019, one in three British workers were unhappy at work, with 45 percent looking to leave their current place of employment. Of those searching for new employment, the most cited reason was to enjoy their work, followed by enhanced pay and job satisfaction. In the United States, a similar sense of dissatisfaction prevails, with evidence suggesting that, in 2022, 60 percent of U.S. employees felt emotionally detached from their work and 19 percent were miserable because of work.43Gallup, State of the Global Workplace: 2022 Report.
Having no alternative than to work for a living, but unable to engage in meaningful work, working-class people’s sense of unhappiness is so prevalent that it has become a collective subjective experience. Except for diagnosed mental health disorders, many forms of mental distress that develop in response to work, such as dissatisfaction, boredom, and unhappiness are considered normal. As Marcuse put it, “while they work, they do not fulfill their own needs and faculties but work in alienation.” Body and mind thus become alienated phenomena and instruments of alienated labor, with little to no control over the production process.44Fromm, The Sane Society, 177.
Consumerism
To compensate for feelings of discontent that emerge from work, consumption becomes a relatively passive method of searching for meaning. Many individuals focus on consumption for personal fulfillment, with material goods consumed less for their use value and more for their symbolic value. The purchase of an automobile, a brand of clothing, or technological equipment, among other goods, commonly pivots on what the product is supposed to communicate about the consumer. Individuals emotionally invest in the meanings associated with consumer goods, in the hope that whatever intangible qualities they are said to possess will be conferred on them through ownership. For capitalism, consumerism constitutes a vital source of economic growth, absorbing surplus and stimulating future investment. Feelings of dissatisfaction from work, subsequently, have economic advantages for capitalism and are even encouraged to stimulate consumption, often by generating a false need and, conversely, discontent for not possessing an item. Rarely, however, is satisfaction truly achieved. What is being consumed is an artificial idea rather than a product that imbues our existence with true meaning or reflects a need predicated on inherent needs.
As a means of identifying a genuine identity and a source to enhance a sense of self-worth and love, consumerism fails significantly. But as a palliative against feelings of discontent and a lack of meaning, the energy and emotional investment channeled into consumption—the anticipation of acquiring it, purchasing it, and its initial utilization—offers enough to dull some of the misery, rendering more tolerable the continued experience of exploitation and oppression. As Fromm asserted, “For most…the culture provides patterns which enable them to live with a defect without becoming ill.”45Fromm, The Sane Society, 16.
At the same time, consumerism can exacerbate poor mental well-being. The prioritization of materialistic values often conflicts with interpersonal relationships. Studies show that accepting materialistic goals can be a barrier to developing meaningful relationships, exacerbating experiencing loneliness and unhappiness in romantic relationships.46Tim Kasser, “Materialistic Values and Goals,” Annual Review of Psychology (2016): 67, 489–514. Moreover, countries with greater wealth inequalities tend to have higher rates of mental health issues. Such countries are more likely to emphasize consumerist values, with large sections of the population accepting these norms but unable to obtain the possessions that wealthy people have.47Richard Wilkinson and Kate Pickett, The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Well-being (London: Penguin, 2019). The result can be anger, frustration, and status anxiety, as success and failure are perceived to be determined by ownership of consumer goods.
Ultimately, like work, consumerism is an alienating experience. The needs and wants of individuals underpinning consumption are frequently manufactured as part of the production process to stimulate demand. The sales effort takes advantage of the despondency and mental fatigue of many working-class people, who are exhausted and oppressed, and offers a solution through assertions that feelings of emptiness, unhappiness, and frustration can be mitigated through consumption.
Alienation and Social Change
Despite the growth of diagnosed mental health issues and the wider existence of a deep sense of mental malaise among many, alienation can be considered the most common mental health issue under capitalism. For individuals with a diagnosed mental illness, these act as clear barriers to having their needs and desires met. The same is true for the many more people who, though not diagnosed with a mental illness, nonetheless experience regular states of dissatisfaction and unhappiness. We live in a society that opposes the development of, or at least makes it difficult to develop, working-class people’s genuine creativity, meaningful and loving connections with others, and a sense of self and identity grounded in personal and collective fulfillment. This causes and normalizes poor mental well-being, separating people from their inherent needs and alienating them from their essence.
The purpose of mental health professionals and services under capitalism is not care, it is to restore individuals to a sense of manageable alienation, whereby people continue to have the capacity to function as exploited workers and consumers, motivated by competition and individualism in interpersonal relationships. In contrast, Fromm asserted that positive mental health must be understood as the adjustment of society to the needs of individuals, not the other way around. “Whether an individual is healthy,” Fromm contended, “is primarily not an individual matter, but depends on the structure of…society.”48Fromm, The Sane Society, 70.
Thus, enhanced mental well-being is predicated on abolishing the exploitation of wage labor, empowering people with democratic economic control, and providing opportunities for meaningful work and collective care. This would mean a society built around real needs and desires rather than exchange values; the provision of housing, education, healthcare, leisure, art, and environmental spaces. A society whose economic system is underpinned by the provision of need, under a system of collective organization, opposes production for production’s sake, shattering alienation, the meaningless pursuit of materialism, and pervasive individualism. A society where work has meaning, the fulfillment of human need is central, and solidarity between its members prevail are the foundations for the growth of mental well-being.