Rebecca Green is a member of Socialist Alternative in the US.
Millions and millions of ordinary people are experiencing a tornado of escalating crises: from COVID-19, social isolation, unemployment and evictions, to the climate meltdown and food insecurity. It is no wonder people are struggling to cope.
In August, the Center for Disease Control released a report saying that one in four young people had seriously considered suicide in the last 30 days. A full 10% of the US population had seriously contemplated suicide in June.
Capitalism poses a direct threat to the physical and mental well-being of the billions of workers and young people that make our economy and society run. The pandemic has exacerbated, and alarmingly accelerated this reality.
The Mental Health Crisis
For years, diagnoses of major depression have been increasing. Nearly 1 in 5 adults in the US live with a mental illness. Deaths by suicide have steadily increased since 2000, particularly among women, and is the 2nd leading cause of death among people aged 10-34.
Symptoms of anxiety and depressive disorders, as well as substance use have increased dramatically between April and June this year. Among high school students, there have been more documented suicides and drug overdoses than deaths by COVID-19 – a statistic that demonstrates not the lack of COVID-19 spread, but rather the widespread nature of severe mental illness.
For the last three years, the average life expectancy in the US fell, largely due to an increase in suicide, drug overdoses, and alcohol-related liver disease. A dip in life expectancy hasn’t happened since WWI and the influenza epidemic that followed it.
The mental health crisis is on an unfathomable scale, and is exponentially worsening.
Yet, less than half of people with a mental illness receive help. In a 2018 study, 74% of people did not believe that mental health services would be accessible, with one in four reporting they would need to choose between getting mental health treatment and paying for daily necessities.
And no wonder: 60% of US counties (and 80% of rural counties) do not have a single practicing psychiatrist. Even where care is available, tens of millions lack insurance and can’t afford the costs. Now, millions more have lost employer-based insurance due to COVID-19 layoffs, and have therefore lost access to life-saving care.
Mental Health Care Under Capitalism
For those who are able to access care, most of the time it comes in the form of medication. One in ten Americans take an antidepressant. However, less than a third of those taking an antidepressant have seen a mental health professional in the last year.
Antidepressants and other mental health medications can be life-saving, and dramatically improve the quality of people’s lives. But it is only one part of the equation. Unfortunately, the influence of big pharma has meant that it is the first and often final response to mental distress, despite extensive research on the effectiveness of alternative treatments.
Studies on non-drug based treatments of mental health problems are rarely funded. Big pharma heavily funds the American Psychiatric Association (APA), and industry representatives made up 69% of the APA task force that produced the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is considered the “bible” of psychology; it defines mental illnesses and suggests treatments. It is no coincidence that it widely recommends medication-based responses.
With for-profit healthcare, the financial interests of the pharmaceutical industry and insurance companies will always come before the health of the general public. Their goal is to maximize profit and cut costs.
The other main prong of mental healthcare under US capitalism is incarceration. The National Alliance on Mental Illness estimates that around 40% of adults incarcerated in the state and federal prison system have a diagnosed mental illness. Chicago’s Cook County Jail, because of the volume of people with mental illnesses who pass through the facility, can be considered the largest mental health facility in the country.
In a mental health crisis, people are more likely to encounter police than get medical help. This was painfully demonstrated when Philadelphia police shot and killed Walter Wallace Jr. when responding to a 911 call from his family to receive help for a mental health crisis. The Philadelphia police department does not have a behavioral health response unit (few do), and the result is the death and incarceration of disproportionately Black and Brown individuals who simply need healthcare.
A starting point to resolve the epidemic of mental illness in American society would be the establishment of a Medicare for All based healthcare system with high-quality, free, mental health services. Rather than dumping billions in taxpayer money into the pockets of private insurance companies and private prisons, imagine if spending was directed toward medically useful research and the development of new treatment options for physical and mental illness. We could make leaps forward in bringing the acute mental health crisis under control.
It is important to note though that even this would not be enough. Treating mental illness needs to be seen in a holistic sense. Beyond alleviating some of the most acute expressions of mental distress, how are we to actually resolve widespread mental illness without resolving the conditions that create it? Poverty, housing and food insecurity, unstable and unfulfilling employment, lack of childcare, racism, sexism, and violence.
What does treatment look like for a woman in an abusive relationship who can’t leave because she can’t afford other housing? What about for a fast-food worker experiencing sexual harassment and grueling, degrading work, but who can’t leave because they need the money to support their family? How do you cure the anxiety of a black man who wonders if he might be killed next by a cop in his home, car, or community? Or the suicidality of a generation staring down existential environmental and economic crises?
Capitalist Roots of the Mental Health Crisis
For as long as capitalism has existed, workers and unions have had to fight to protect their health from the conditions bred by a society blindly pursuing profit. In the workplaces, this has meant winning victories like the eight hour work day in the early 1900s, or fighting for a safe reopening of schools under COVID-19 in 2020. This struggle continues today, where we need to continually fight against the exploitative conditions that cause us to become mentally and physically unwell. Fighting against abusive managers, toxic work environments, long hours, lack of benefits and poverty wages are part of the fight for our own mental health.
Under the for-profit system of capitalism, the vast majority of people in society have to work in order to survive, as we are not guaranteed food, water, shelter or healthcare. A very small minority own the factories and stores that everyone else works in. As Marxists point out, these capitalists don’t have to work to survive, and instead exploit the labor of their workers and the raw materials of the earth to make enormous sums of money. They constantly try to drive down wages, cut benefits, cut corners on safety measures to speed up productivity, and use cheaper more environmentally damaging materials to get richer and richer.
Workers and youth have no control over the products of our labor: the capitalists tell us what we make, how we make it and who it’s for. For most people, work is something to grit our teeth through because we need to pay the bills. Karl Marx used the term “alienation” to describe this reality of capitalism, where those who have to work to survive are completely removed from what we make and how we make it. This lack of control and agency is extremely unfulfilling: we wait for orders from someone who is making their decisions based on profit, not our needs as workers and definitely not our health.
So beyond fighting for changes at the workplace level and for reforms like Medicare for All – things that would all have a net positive effect on our collective mental health – without rooting out the entire system of capitalism, it is impossible to imagine a world free of endemic mental illness. Inequality is baked into the system of capitalism, and is a huge contributor to the mental health crisis. In The Spirit Level: Why Equality is Better for Everyone, the authors show that inequality of wealth and income are the biggest determinants of social wellbeing and quality of life. And this is not just because the poor drag down the average – even the well-off do worse in more unequal societies.
Inequality breeds insecurity: if you don’t have a safety net, and when there’s a long way to the bottom you’ll be afraid to fall. Insecurity brings constant stress, which acts as a trigger to various physical and mental illnesses. Research from the Journal of Biosocial Science shows that in more equal societies, people with genetic predispositions for physical and mental illnesses are less likely to become sick than those in more unequal societies with high levels of stress.
Capitalism is also a breeding ground of racism, sexism, homophobia, and transphobia. These and all other forms of oppression have not existed for the entirety of human kind, but exist in their particular forms under the system of capitalism to hyper exploit oppressed groups and keep the working class and youth divided. The legacy of these forms of capitalist oppression is that Black and Brown people, women, LGBTQ+ folks, the disabled, and other oppressed groups are poorer, more likely to be unemployed, evicted and homeless, work low wage jobs, and yes, more likely to suffer from mental illnesses.
While genetic and biological factors are at play, exposure to the exploitation, alienation, inequality, stress, violence, and trauma of capitalism is the root cause of the mental health crisis. The COVID-19 pandemic has simply accelerated the existing features of our society: tens of millions are now unemployed, at risk of eviction, and going hungry. These conditions are a breeding ground for stress, trauma, neglect, abuse, addiction, and mental crisis.
It Doesn’t Need to Be Like This
Human beings are profoundly social creatures – the key to our survival and evolution as a species has been our social bonds and the development of language to communicate. But since the industrial revolution and general migration away from small villages, we have become much more separated and atomized. The features of capitalism described above exacerbate that process. Study after study shows that having a good support network is the single most powerful protection against becoming seriously impacted by a traumatic event.
Of course, the capitalists understand this and the threat that social bonds pose to their system. The bosses hate unions, which bring workers together to collectively fight for better and safer working conditions and broader political issues. Corporate politicians have decimated funding for community centers and our public schools. And historically, it has always been mass movements of the united working class, youth and oppressed that have toppled dictators and changed the organization of society.
Under socialism, there would be no need for unemployment and the devastation that comes with it under capitalism: we could share out work with no loss of pay, freeing up time for people to spend with their families and friends, exercise, enjoy leisure activities, and cook healthy food, which are all crucial for mental wellness. We could put millions back to work retooling a green society and energy sector, reforesting the planet, training as healthcare workers and educators, and more.
Healthcare, food and shelter would be guaranteed. Workers would have a say in the decisions at their workplaces: construction workers would no longer be building luxury apartments they can’t afford, or healthcare workers filling out endless insurance paperwork instead of spending time with their patients.
The profound and widespread experience of mental suffering is not a permanent feature of human society and under these conditions would be greatly alleviated. The mental health crisis is a symptom of the profoundly diseased system of capitalism that is only getting sicker. It is urgent that we fight immediately for a massive expansion of free, accessible mental health services for all. This includes medication for those who need it, but crucially also individual and group therapy services.
But even if every person experiencing mental illness had this type of access, it still would not address the material conditions of so many people’s lives. The fight for robust mental health services needs to be tied to a fight for Medicare for All, affordable housing, a Green New Deal jobs program and full funding for our schools and community centers.
While the alienation and isolation of capitalism is making us sick, the fight for a healthier society will require mass participation, collaboration, and connection of the working class and young people. One of the most rewarding experiences for human beings is the collective struggle for a better world, where we are united across race, gender, sexuality and ability to fight for what is right. From the 2018 educator strike wave to climate protests to the recent Black Lives Matter rebellion, those who have participated in or seen these movements know the unbreakable solidarity and community that is forged in struggle, that can overcome the alienation and misery of capitalism.
A mass movement will be necessary to overthrow this exploitative system, and it will also be necessary to build a sustainable, socialist society, which is democratically run and planned by workers and youth to meet everyone’s needs, where mental and physical health is a central priority of the organization of society.
Socialist Alternative Canada demands:
Expand public health to include full coverage of robust mental health services.
Tax the wealthy and big business to massively fund mental health care, from community based health organizations providing therapy services to counselors in all of our schools. Use this money to also fully fund our schools, community centers, and community based art and culture programming!
Massively invest in affordable housing and fight for universal rent control. Cancel rent and mortgage payments during the COVID-19 pandemic, and extend federal and local eviction moratoriums.
We need a Green New Deal now! Put millions back to work building the renewable energy sector and green infrastructure, weatherizing homes, and massively expanding public transportation.
Take big pharma into democratic public ownership, and begin investing in research for alternative and holistic treatments to mental illnesses. Under democratic public ownership, the industry should be directed to coordinate in the rapid development and distribution of a COVID-19 vaccine.
Fight for a socialist society where everyone is guaranteed housing, healthcare, food and shelter which can lay the basis for ending racism, sexism, homophobia, transphobia and all forms of oppression once and for all.
Capitalism is a threat to our health: we need to fight for a socialist society, where workers and youth democratically plan and run the economy on the basis of need, where work is shared out to eliminate unemployment and shorten work weeks, so people have more time for their families and leisure activities, and where mental and physical health is a central priority of the organization of society.
