In his riveting study, What about me? The Struggle for Identity in a Market-Based Society (trans. Hedley-Prôle, J. London: Scribe Publications, Kindle edition, 2014), the Belgian psychoanalyst, Paul Verhaeghe, gives a resoundingly affirmative answer to the question: “Is there a demonstrable connection between today’s [neoliberal capitalist] society and the huge rise in mental disorders?” Many of us already knew this but Verhaeghe’s new book supplies one with incontrovertible, documented evidence.
It is impossible to do more in a blog post than provide a kind of overview of the book’s central thesis. In the introduction, after stating that since an earlier book (in which he investigated the connection between social change and mental disorders), he has become convinced that the effect of such change is far more significant than previously realised, he remarks: “The neo-liberal organisation of our society is determining how we relate to our bodies, our partners, our colleagues, and our children – in short – to our identities. And you can’t get much more disordered than that”.
What does the neoliberal “organisation” of society amount to? As the title of the book indicates, it is market-based, in the tacit belief that the abstract entity called the “market” is better suited than human beings themselves to provide a (supposedly) humane structure to the communities in which we live. But because neoliberal capitalism stands or falls by the question, whether profit is generated or not, it means that human economic activities in such a society have to generate optimal profit.
Predictably, according to the profit-driven dictates of the market, workers/employees in every organisation, from small companies to large corporations and even what used to be regarded as public institutions such as schools and universities, have been increasingly subjected to a regime of relentless competition, linked to rewards (such as promotion and bonuses) for productivity and punitive measures (no promotion, no bonuses, being fired) for lack of it. This has gone hand-in-hand with quasi-legal measures to ensure the productivity of employees and the identification of those who are not productive, such as the imposition of production-deadlines, self-assessment and company audits. Not even schools and universities have been exempted from this. It was not difficult to guess what effect these transformations in working conditions would have on people’s health.
Among those focused on by Verhaeghe are psychiatric conditions (the incidence of which has multiplied) like depression, eating and personality disorders and depression. Nor is it difficult to guess why this should be the case – if one feels that, no matter how hard you try, it is just not possible to be as productive, or as innovative regarding product-design as some of your colleagues, depression and anxiety are likely to assert themselves sooner or later.
It is, therefore, not surprising to find that the most commonly occurring personality disorders among working people today (and even executives are not exempted from this) are social phobia and performance anxiety. Why would this be the case, the less perspicacious among us might wonder. The answer should be obvious: in a society where those around you in the workplace either fall into the category of competitors (including your best friends at work) or those who have the task of evaluating your own performance (sometimes they are both), it is difficult not to experience anxiety intermittently, which could easily develop into a pathology. Social phobia has the same origin – involuntarily, you start fearing people’s motives when they talk to you about your work, and again this could burgeon into a pathological condition.
As an aside I should mention that, in my own judgment, these findings on Verhaeghe’s part are compatible with something I argued in a previous post (see: http://thoughtleader.co.za/bertolivier/2013/08/30/capitalism-andas-suffering/), namely that capitalist work displays an “obsessional neurotic structure” – even on the part of those who are not clinically “ill” – insofar as, for reasons outlined above, it demands of workers (executives included) a painfully repetitive, conscientious commitment to productive work, on the tacit assumption or belief that “something terrible” would happen to them if they should fail to do so. And anxiety or fear and depression are always waiting in the wings, lest one should feel, as one invariably does, sooner or later, that one is not meeting expectations (which have by then been internalised).
What is the connection of Verhaeghe’s work with neoliberal capitalism? Again, it should be obvious: in what has become a society dominated by – let’s be honest about it – nothing less than market fundamentalism, competition and reciprocal (in terms of company structures, horizontal as well as vertical) evaluation are virtually the only functions that are allowed, or at least, valorised. But how does one “know” that you are not adequately competitive, that is, that you are not “successfully competing” with your peers?
Again I have to condense brutally. First Verhaeghe shows that the dominant medical view (the “illness model”), that mental disorders are the manifestation of “underlying bodily processes”, and therefore have nothing to do with the state of society in which patients live, is losing support. This is evinced by the recent criticism on the part of the British Psychological Society and the World Health Organisation, of the newly published Bible of psychiatry, or the DSM. In both cases these organisations pointed out explicitly that the diagnoses enshrined in the DSM ignore the fact that such diagnoses are largely based on social norms (something Foucault argued ages ago).
The proliferation of so-called mental disorders today have to be seen in this light. The neoliberal practice of salary differentiation, linked to performance, and the resulting income inequality (characteristic of neoliberal societies) is where to look. Verhaeghe – no doubt anticipating accusations of not being sufficiently “scientific” in his writing – therefore turns to the work of two eminent, widely respected social epidemiologists, Richard Wilkinson and Kate Pickett, under the headings, “Mental disorders as social problems” and “Too much inequality is bad for your health”.
Pickett and Wikinson’s findings were unambiguous (Verhaeghe 2014: location 2365): “… an increase of this kind [income inequality] has far-reaching consequences for nearly all health criteria. Its impact on mental health (and consequently also mental disorders) is by no means an isolated phenomenon.” The key factor in their study proved to be stress, which has been shown to have an impact on human cardiovascular systems as well as immune systems. And stress (indirectly it seems to me anxiety and social phobia too) is directly linked to income inequality. A salient conclusion of Wilkinson’s first book The Impact of Inequality: How to make sick Societies Better was already that in a city or a country where there is high income inequality (need I say like South Africa) “the quality of social relationships is noticeably diminished: there is more aggression, less trust, more fear, and less participation in the life of the community” (2014: location 2375). It seems to me that these findings are not unrelated to what happened at Marikana two years ago.
One should keep in mind that income inequality is directly linked to differences in social status. And not surprisingly, Verhaeghe points out that low social status has a “determining effect on health” (2014: location 2375). He therefore arrives at the startling conclusion, that even in “prosperous … Western Europe, it isn’t the quality of health care … that determines the health of the population, but the nature of social and economic life. The better social relationships are, the better the level of health” (location 2375). And health has been deteriorating steadily under the neoliberal regime. Need I say more?