Towards a Leftist Psychotherapy

Millions of Britons are suffering from stress-related mental disorders. The number of people with anxiety has been steadily rising for years. According to NHS statistics, more than six million people in the UK are taking antidepressants.

There is an acceptance that wide-scale mental distress is an unavoidable part of modern life. The general response to the crisis by government bodies and the media is to call for more treatment. While increased support is necessary, the focus on treatment hides the extent to which society is often responsible for personal distress.

The cause for much of this depression is social and political. Under neoliberal governance, workers have seen their wages stagnate and their working conditions and job security become more precarious. The individualising and privatising forces that underpin capitalism have led to the breakdown of communities and social bonds, leaving millions of people lonely.

Given the increased reasons for anxiety, it’s not surprising that a large proportion of the population diagnose themselves as chronically miserable. Converting that depression into a political anger is an urgent political project. This should be the job of the left, who are the natural critics of capitalism. I believe that we should develop a kind of ‘leftist psychotherapy’ in which mental distress is explained in relation to the power structures of society.

In this endeavour the work of British clinical psychologist David Smail (1938-2014) is instructive. His writings provide a searing critique of the psychology establishment, and a social constructivist model for how to better understand mental distress. I believe that building on his work could have a tremendous impact.

The Role of the Psychology Establishment

In his seminal text Power, Interest and Psychology, Smail explains how mainstream psychology reinforces the status quo. It does this by diverting us from connecting mental distress to the material circumstances that condition our lives. ‘The psychology establishment has nothing to say about how to apparatus of power and interest that so clearly operates at the level of society comes to be reflected in the subjectivity of individuals – or even whether it does’.

Psychology has become a technical profession, like chiropody or dietetics, which focuses on the pragmatics of relief rather than on any more abstract intellectual or scientific enterprise. The dominant forms of treatment in mental illness are drugs and therapy.

Antidepressants contain people’s depression rather than actually deal with the causes of depression. The focus on brain chemistry creates a horrible loop whereby massive multinational pharmaceutical companies sell people drugs in order to cure them from the stresses brought about by working in late capitalism. In this context, the message to patients is cruel; if you’re depressed because of overwork, that’s between you and your brain chemistry!

Smail was critical of therapy. He suspected that it is only effective to the extent that the therapist becomes a true friend to the client, involved in their world. The supposed process by which people are ‘cured’ of mental illness once they gain ‘insight’ into their problems is illusory, and therapists are to a large extent involved in wishful thinking.

He argued that therapeutic psychology gives patients a false understanding of reality. The focus on the individual turns ‘the relation of person to world inside out, such that the former becomes the creator of the latter. If the story you find yourself in causes you distress, tell yourself another one’.

Counsellors and therapists have a stake in maintaining an individualist and idealist account of emotional distress, for only such an account can legitimate the role of professional practitioner. ‘Psychology tries to be objective like a science – explanations of activities or interests undermines the ‘scientific’ rationale for our practice’.

This is not to say that drugs or therapy are harmful. Being able to talk to someone for an hour in therapy or having something which will take the edge of things via anti-depressants can make people feel better, but it doesn’t get to the sources of that sort of misery in the first place.

A Sociomaterialist Explanation of Mental Distress

Smail argued that feelings of well-being fundamentally arise from a public world. And in a society in which the concept of the public has been so viciously and systematically attacked – it’s no surprise, he argues, that distress has increased.

Interest and power are what determine events in our lives more than we are allowed to acknowledge. ‘The strength and integrity of the subject is determined not (as therapeutic psychology would have us believe) by efforts of individual will, but by the adequacy or otherwise of the environment (including, crucially, the public societal structures) in which it is located.’

It follows that where public structures are stable, supportive and nurturing, the individual may blossom and flourish; where they disintegrate the subject becomes demoralised and depressed.

To solve the mental health crisis we must ask broader ethical questions about how we treat each other. ‘We are bodies in a world: of course, in a physical world, but also a socially structured, material space-time in which what we do to each other has enormous importance’.

A Way Forward

To solve the mental health crisis it is necessary to critique the social conditions that we live in. Widespread mental illness is a hidden cost of neoliberal capitalism. Market forces have created heightened instability and alienation which has resulted in mass psychological distress.

The medical establishment reinforces the status quo by privatising stress. Those who struggle to meet the expectations of society are told that the problem is their family background or in the chemical make-up of their brain. There is a case to be made that anti-depressants and therapy are now the opiates of the masses.

As a collective, there is an urgent need for us to connect mental distress to systems of power and interest. If someone struggles to meet the cost of living, or to cope with the instability of working in the gig economy, it is vital that they understand that millions of other people are suffering for the same reasons.  Those incapacitated by depression and anxiety often feel tremendous guilt and self-loathing.  By connecting their illness to broader social forces, they may apportion less blame to themselves.

We need to challenge the idea that wide-scale mental distress is an unavoidable part of modern life. The kind of world we want is an ethical choice. We are not bound to accept that the ‘real world’ is one in which the ‘bottom line’ defines what is right and wrong. The ruthless world may be chosen, as it is by the current rulers of the globalised neo-liberal market. It can also be rejected.

The awareness that neoliberal governance is causing wide-scale mental distress can be a catalyst for social change. The left can drive this process by developing a ‘leftist psychotherapy’ that provides a theoretical framework for how the material conditions that we live in cause mental illness.

Growing up in the UK, David Richards felt that the country was in terminal decline and that the social fabric of society had been destroyed by neiliberalism. He decided to become a social studies teacher and work abroad. He has taught in Vietnam, Mongolia, Russia, and China. He now wants to partake in an international socialist movement that can provide solutions to the problems of the 21st century. Read other articles by David.