Cleansing the UK’s Mentally Ill, Sanction by Murderous Sanction

‘The Match Seller’ by Otto Dix: as the UK’s disabled are sanctioned into beggary, to the apparent unconcern of the wider populace, a painting that resonates beyond Weimar Germany

 

He who does not work, neither shall he eat.

II Thessalonians 3:10

 

On his blog, A Day in the Life, the Pathways group’s Dave Sweetsur has written recently about the issue of benefit sanctions, one of the morbid symptoms of the senescence of capitalism. A sanction is a penalty levied on unemployed persons, whether ones claiming Jobseeker’s Allowance (JSA) or the main type of Employment and Support Allowance (ESA), for what Iain Duncan Smith’s Department for Work and Pensions (DWP) moralistically terms “transgressions” against the rules pertaining to their benefit claims. Where they are not pure inventions of target-driven jobcentre staff, these “transgressions” are generally of an utterly trivial nature, as a glance at the several websites documenting them will show. They can consist of nothing more heinous than spelling mistakes on a form or marginal lateness for an appointment. The consequences of being subject to a sanction, however, are anything but minor. All financial support, or a hefty portion of it in the case of ESA recipients, ceases for a period ranging from a week to a scandalous three years, plunging those affected into an existential battle for bare survival. Theoretically, hardship payments are claimable to counter a slide into abject destitution, but in practice these are scarce, and in any event are to be disbursed as loans when current benefits undergo the transition to Universal Credit. Sanctions are now handed out by the thousands, outstripping in number the fines imposed by magistrates’ courts. As a sanction also serves to remove a person from official unemployment statistics, they go a considerable distance toward accounting for ostensible falls in those totals. The topic is of such grave import that the present author, Mark Conlon, felt that it warranted a second look here.

Dave drew connections between the manifest iniquity of sanctions and Hannah Arendt’s “banality of evil” thesis, positing the DWP as an Eichmannesque “bureaucratic framework of oppression” implacably grinding expendable lives into dust. He articulated the shock and disbelief experienced by many when they realize what is going on in purportedly civilized twenty-first century Britain. Is it conceivable that human beings are being cast adrift without access to money, the sine qua non of existence in a capitalist society? That, to quote Aneurin Bevan’s famous Bellevue Hotel speech of July 1948, the condemnation of “millions of first-class people to semi-starvation” is once again the method by which Tories prefer to deal with economic slump? Unfortunately, from the standpoint of neoliberal ideology the answer is an unabashed yes. More, state-mandated penury is to be celebrated as both condign punishment and tough love: a just retribution against the incorrigibly workshy, and a stern exhortation to the rest to buckle down to a life of wage slavery, the strait gate which alone offers redemption from the mortal sin of profaning bourgeois relations of production. The apodictic pronouncements of the DWP make explicit what in effect is a species of Augustinian theology, whereby the supplicant “jobseeker” is expected to embrace servitude with masochistic elation, or else suffer damnation to a very real hell. Take, for example, a typical piece of sanctimony from the detestable Esther McVey, Minister of State for Employment. Speaking of the department’s plans, via psychometric testing, to “segment” the unemployed into subsets of deserving and undeserving poor, she explained that the former are those exhibiting “get up and go, the right attitude, the right teamplay.” Arbeit macht frei, indeed.

Since June 2011, stricter “conditionality” (i.e., the obligation to jump through an ever proliferating myriad of bureaucratic hoops) has reduced the sanctioning apparatus to a Kafkaesque circus of cruelty and absurdity. Campaigning body 38 Degrees characterizes as “economic terrorism” the clear intent to inflict an annihilating precarity on an already vulnerable demographic, while Professor David Webster, of Glasgow University, talks of a “parallel secret penal system” having been assembled around sanctioning legislation. The maliciousness of sanctions is so glaring that a Conservative minister, Nick Boles, was struck by unaccustomed, if transitory, pangs of conscience over what he called an “inhuman inflexibility” in their operation. All this, it is pitiful to recall, is to prevent payment of derisory sums of money, which when added up annually would scarcely fund the upkeep of an MP’s moat, much less foot the bill for the $70,000 desks favoured by bailed-out bankers. JSA is a parsimonious £72.40 per week, and accounts for a mere 0.7% of government spending; ESA rates are only nominally higher. Any rational observer can see that inevitably the policy must issue in calamity. Personal indebtedness will rise to unserviceable levels, indigent people will be driven in desperation to crime, homelessness will ensue, and families will have to assume the financial burden of supporting those who are sanctioned, whose health is likely to deteriorate to the point where medical crises place great strain on the NHS. The Medical Research Council has warned, ominously, of “a public health emergency that could go unrecognised until it is too late to take preventative action.”

What of the fate within this draconian setup of the mentally ill? Clare Bambra and Kayleigh Garthwaite of Durham University have conducted research in Stockton-on-Tees into the impact of sanctions on those with mental health conditions. Their findings were horrifying. They discovered that Karen, a single mother on Jobseeker’s Allowance with children aged nine and eleven, had been sanctioned for failure to apply for a stipulated minimum of jobs – no fewer than seventeen – over the Christmas period of 2013. All three were left penniless, without the means to heat their home in the depths of winter. Jessica, a heavily pregnant woman of 23 previously in receipt of Employment and Support Allowance, but guilty of the unforgivable offence of being too ill to attend a jobcentre interview, told them that she had barely eaten for two weeks following a withdrawal of benefit. Her access to nutrition was restricted to the charitable donations of a Trussell Trust food bank, augmented by leftovers supplied by her sister; no money was available to power her fridge or cooker. Evidently, for those who administer this mockery of anything that might properly be termed a “social security” system, there exists no season of goodwill, nor duty of concern for the wellbeing of unborn babies. In light of the case studies presented, one must view the following statement by the Durham academics as an illustration of scholarly understatement: “The sanctioning of people with mental health problems is a particular problem – with the stress and anxiety of income loss adding to their underlying condition.”

In evidence submitted to the Commons Work and Pensions Committee, Bambra and Garthwaite urged that sanctions be scrapped or mitigated for those with psychological ailments. The most recent data, from 2014,  indicates that the opposite course is being pursued. Mentally unwell ESA claimants allocated to the Work Related Activity Group – a category for those deemed capable, often on the basis of bogus or inept assessments, of working at some future point – are being sanctioned at the rate of over a hundred per day. There can little doubt, in fact, that the mentally ill are being specifically targeted. They not infrequently ignore or delay opening mail, something the DWP seemingly regards as all the more reason to send out letters and impose penalties when the instructions therein are not obeyed punctiliously. They simply may not understand the workings of a Byzantine system, but this renders them easy prey for jobcentre “hit squads” (the description of whistleblower John Longden) tasked with tripping them up at every turn. Overall, a staggering six out of ten of those sanctioned have mental health diagnoses. There have been a number of victims whose maltreatment has been so egregious as to breach the carapace of media indifference. Ken Holt, for instance, has spoken to the press about his conviction that his bipolar daughter, Sheila, “cracked” under the pressure of endless threats that she would be sanctioned for not measuring up to the demands of the Work Programme, the government’s corporate welfare scheme designed to shovel public cash into the coffers of “training providers” such as Seetec and A4E. Sheila was sectioned, suffered a heart attack and subsequently fell into a coma. Even when she was comatose, the hectoring from the DWP did not relent. She has since died.

It hardly requires saying that a government capable of this degree of callousness  – as George Monbiot puts it, one with a parliamentary frontbench that “can rock with laughter as it truncates the livelihoods of the poorest people of this country” – is catastrophically lacking in empathy. Its leader, David Cameron, while presiding over mass hunger and an upsurge in food banks, can announce without irony that his eleven-year-old daughter will be going on “hunger strike” in opposition to the sacking of a brawling right-wing celebrity from the BBC. It would not baulk for a moment at the liquidation of all social security provision. Since the Labour Party introduced sanctions with its Clintonesque “New Deal” retrogressions, a detail of history to which Shadow Work and Pensions Secretary Rachel Reeves is unembarrassed to advert, it would be naïve to hope that a Labour administration might fundamentally alter things. With much of the population benumbed by propaganda scapegoating “scroungers” and the supposedly numberless hordes of benefit fraudsters, or at such a nadir of political consciousness as to look to poujadiste racists for solutions to an unfolding crisis of capitalism, the outlook for mentally ill people without jobs (that is to say, the majority) is exceptionally bleak.

Hannah Arendt, in a 1951 letter to Karl Jaspers, suggested that evil resides in “making human beings as human beings superfluous.” That is exactly the principle on which the sanctioning regime operates: it declares the frail and the fallible, those not able to conform to the dictates of an apparatchik machine – those who fall, as one might phrase it, outwith the Volksgemeinschaft of self-reliant citizens – to be unfit to live. It’s one reason I don’t consider as gratuitous the parallels drawn by Dave Sweetsur between the fascist nightmare and what’s occurring today (a worry that Dave, ever the scrupulously fair-minded liberal, has expressed to me). Certainly Dave is not alone in making the comparison. Disabled People Against Cuts (DPAC), in vigils held outside Downing Street and Parliament, has combined antiausterity protest with commemoration of the Holocaust. Disabled rights activists Black Triangle borrow their name from the badge that denoted “asocial” prisoners (including the mentally ill) in Nazi concentration camps. In 2012, The Guardian newspaper revealed the Coalition’s predilection for eugenics in a report on the £166 million in foreign aid given to India to expedite forced sterilization of the poor in Bihar and Madhya Pradesh. Whatever the present differences in scale and overt savagery, when a government broadcasts its contempt for human rights, and its intent to abolish the Human Rights Act after the 2015 general election, one can only fear a descent into worse forms of barbarism. One begins to glimpse what the much trumpeted “longterm economic plan” might have as its endgame: elimination of uneconomic Untermenschen.

To conclude on a personal note. Today I’ve turned 50 years of age. It’s dispiriting, to choose a mild adjective, to have spent 36 of those years – longer, if one dates the birth of neoliberal governance to the Callaghan administration of 1976 – under a darkening shadow of political reaction. It was obvious from the start that the neoliberal project (Thatcherism, monetarism, supply-side economics, call it what you will) was a bid to conduct an extirpative long march through the institutions of social democracy. It was impossible, however, to predict how far it would go. I am the last person to wax nostalgic about the era of my youth, the 1980s; we were still, as Marx would have it, in prehistory, and a pretty coarse and nasty one at that. Nonetheless, it was at least a prehistory in which workers, after a century of struggle, had won a modicum of dignity. Disqualification from unemployment benefits was rare, denial of all state assistance beyond the parameters even of Thatcherite immoderation. The “enemy within” was the National Union of Mineworkers. Thirty years on, with organized labour vanquished, and under the cloak of fiscal discipline, the enemy is the unemployed and the disabled, and by extension everyone in the country not insulated by wealth against the potential misfortune of unemployment or disability. If I were to indulge in a middle-aged cri de coeur, it would be the hope that, in the time left to me, the tide finally turns against a capitalist triumphalism that is dragging nearly all of us down to perdition. The victims of sanctions, together with all the other victims of neoliberalism, surely deserve no less.

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The Prison as Neoliberal Madhouse

An American Konzentrationslager: Wallen Ridge super-maximum security prison in Virginia, a 700-inmate experiment in the propagation of insanity

 

Jails and prisons have become the final destination for the mentally ill… it’s the most pressing issue facing psychiatry today.

Psychiatrist Steven Lamberti

 

At the Pathways session on 15 July 2014, the present author, Mark Conlon, together with other members of the group, watched a disturbing television documentary. An investigation in the BBC’s veteran current affairs series Panorama, ‘Bedlam Behind Bars’ addressed an especially reprehensible aspect of America’s neoconservative devolution, namely the hyperbolic growth of US prisons and their role in the criminalization of the country’s mentally ill citizens. It was originally broadcast on 11 July, and we’re grateful to Darren, one of our recent recruits, for bringing his recording of the show to the meeting.

Reporter Hilary Andersson discussed the plight of more than a million psychiatrically disturbed prisoners immured in a carceral leviathan from which, on the evidence of the programme, all vestiges of humanity have been obliterated. Viewers were shown a young bipolar inmate in a Michigan prison, Tim Souders, jailed for the heinous offence of stealing paintball guns. He was seen heading into solitary confinement as punishment for an infringement of prison rules. In the middle of a heatwave, the water to his cell was disconnected, and he was shackled to a concrete slab. Within a day, he had become delusional. After five days, he was shifted to another cell and again chained down, this time stripped of his urine-soaked clothing. He strained to feed himself slices of bread flung onto his bare chest. Eventually, death resulted from dehydration and the excessive temperature. Moving on to Chicago’s overflowing Cook County Jail, we glimpsed a fraction of the 30% to 50% of inmates, totalling possibly 30,000 per year, assessed as having significant psychological ailments. The jail, along with Rikers Island in New York, is effectively one of the two biggest psychiatric facilities in the United States, even if not officially classified as such. The sheriff in charge, Tom Dart, conceded that it is no place for those with mental health diagnoses, and it was impossible to disagree after hearing of detainees assaulted by his own officers, or left to languish in squalid cells for twenty-three hours a day. And so it continued through a litany of hideous malfeasance, from pepper spray-assisted cell extractions ruled “cruel and unconstitutional” by a federal judge, to frigid isolation cells and recourse to leg irons and belly chains in a panopticon-like suicide unit in Houston’s Harris County Jail. By the end one was thankful that, in the era of dumbed-down media and dwindling attention spans, Panorama has been truncated in length from an hour to thirty minutes. As with Alain Resnais’s Night and Fog, sometimes concision is preferable to a surfeit of horror.

‘Bedlam Behind Bars’ was a cogent indictment of institutionalized savagery, but nevertheless it may be useful to have some context beyond the programme’s largely ahistorical and wholly apolitical examination of its subject, not to speak of the Corporation’s tiresome insistence on “balance” via prison administrators’ insidious defence of the indefensible. (For much of the information that follows, I’m indebted to Alan Elsner’s book Gates of Injustice: The Crisis in America’s Prisons, a critique all the more damning for being written from a standpoint of irenic reformism.) It is a sorry tale indeed. The US imprisonment rate, which for most of the twentieth century hovered around a normative 0.1% of the population, began in the mid-1970s to soar to grotesque levels. A landmark was reached in 2008 when it passed the 1% mark; since 1980, it has risen by a colossal 790%. As psychologists Craig Haney and Philip Zimbardo (of Stanford Prison Experiment fame) put it, a “runaway punishment train” has been set in motion, one that has overtaken in punitiveness such exemplars of penal enlightenment as China, Iran and Thailand. A “war on drugs” rhetoric, bolstered by zero-tolerance policing and rigid “three strikes and you’re out” legislation, furnished the alibi for a sweeping incarceration of those deemed surplus to requirements in the Hobbesian bellum omnium contra omnes of ascendant neoliberalism. In his memoirs, Edwin Meese III, Ronald Reagan’s attorney general, summed up the paradigm thus: “At the Reagan Justice Department, my predecessor and I carried on a continuing crusade… arguing for tougher and more effective sentencing, stressing the protective rather than the ‘rehabilitationist’ model of penology, and pushing for construction of additional prison space so that convicted criminals could be kept away from society.” To state it in language less redolent of the banality of bureaucratic evil, prisons expanded to become, to quote Angela Davis’s fine polemic Are Prisons Obsolete?, “a black hole into which the detritus of contemporary capitalism is deposited.”

All this, a tightening “culture of control” as penologist David Garland characterizes it, would have been bad enough merely as state-orchestrated repression. Worse, in a process the Wall Street Journal dubbed in 1994 an emergent “prison-industrial complex” – a counterpart to the bloated “military-industrial complex” identified by Eisenhower – prisons have morphed into privatized businesses, or what Mike Davis more piquantly terms “hell factories” in a 1995 scrutiny of the phenomenon in The Nation. The trend has been exacerbated by budgetary constraints in the wake of the 2008 financial crash. Crony capitalists such as the Corrections Corporation of America and the GEO Group pocket government fees for running institutions dedicated to wringing profits from wretchedness and despair. GEO, in its former incarnation as Wackenhut, issued a statement fulsomely priding itself on “a turnkey approach to the development of new correctional and mental health institutions that includes design, construction, financing, and operations.” Translating from corporate cant, what this means is that staffing ratios and per capita inmate spending are drastically cut, while prisoners toil, across a vast range of jobs from clothes manufacture to computer assembly, for wages of less than $1 per day, a resurrection of the “contractual penal servitude” of the 1820s and slavery in all but name. After drudging for their nominal remuneration, they have insult piled on injury through being charged preposterous sums for accessing substandard medical services. “There is no way to justify handing convicted criminals free health care while law-abiding taxpayers are required to make co-payments for health services,” thundered Republican Senator Michael F. Nozollio, touting his sponsorship of 2002 legislation designed to impose on felons charges of $7. “By revoking this policy, we will bring justice to both the criminals who thumb their noses at the law and to the law-abiding citizens struggling to pay for their own health care.” No matter that some of those billed will be in custody because they cannot afford bail, or that others are incarcerated for transgressing laws that would not be on the statute but for the avid lobbying of GEO and its ilk.

US penal doctrine is deeply entwined with race and class: one in three black and one in six Hispanic men will be imprisoned at some point in their lives and, with rare exceptions, only the poor find themselves behind bars. There are more African-Americans in prison than there were slaves in the antebellum South. Increasingly, however, prisons function too as substitute asylums; as the latter were emptied from the 1960s onward, prisons assumed the task of inoculating society against the “deviancy” of people who could not adapt themselves to the iron-cage “rationality” of a capitalist economy. An assertion of Michel Foucault, that asylums, factories and schools are all cognates of the prison, is being verified more palpably than Foucault foresaw. It hardly needs emphasizing that prisons are ill-suited to serve as surrogate sanatoria. Rape, with the posttraumatic symptoms that arise from it, is rife, perpetrated by inmates and wardens alike. Prisoners whose reactions are slowed by psychotropic drugs may struggle to obey orders with the mandated alacrity, but often dosages are increased with the aim of enforcing conformity, a vicious circle whereby shambling wrecks of human beings – victims of what sardonic prison argot calls the “Thorazine shuffle” – are handed ever harsher punishments for falling short of the brisk deference demanded. Those harder punishments include solitary confinement, something that in short order can corrode the psyche of even the mentally robust. Psychiatric professionals, where they exist, typically ally with prison officers in taking an antagonistic stance toward those ostensibly under their care. At the East Mississippi Correctional Facility, currently being sued on behalf of inmates by the American Civil Liberties Union, a psychologist’s treatment plan for a suicidal prisoner comprised three words: “Encourage behavioral compliance.” The method of compliance chosen was to use Mace to asphyxiate the man in his cell. The worst conditions prevail in the seclusionary “supermax” facilities that proliferated in the 1990s, where an almost total lack of human interaction seems calculated to induce psychological turmoil, up to and including florid manifestations of psychosis. Then there is death row, a setting so depressing that many elect to escape it by waiving appeals in favour of the desperate “volunteerism” of embracing execution.

Where America leads, Britain as piteous lapdog generally follows, in this area by adhering to the US template of populist “law and order” asperity generating a plentiful supply of convicts ripe for exploitation in pursuit of the sacred goal of shareholder value maximization. Britain’s prison population is at a record high of 85,000, housed, or perhaps one should say warehoused, in 126 institutions, with more serving life sentences than in all other European nations combined. The sharp rise in numbers is entirely due to stricter sentencing rather than an escalation of crime (in Foucauldian terminology, a discourse of punitive reason has become detached from actual illegalities). In November of last year, Justice Secretary Chris Grayling, not content with the morbidly tyrannical prisons-within-prisons of such “close supervision centres” as the notorious Woodhill in Milton Keynes, introduced a gruelling regime of solitary confinement throughout the system. The practice was castigated by the United Nations in 1990, and declared unconstitutionally torturous by the US Supreme Court as long ago as 1890, yet is championed by Grayling as a counter to what he ludicrously portrays as the “frills” of liberal governance. Even when not subjected to this ordeal, the default status of inmates is now a “basic level” of obligatory prison uniform and deprivation of personal possessions. Grayling’s bibliophobia has occasioned greater press coverage, but arguably these dehumanizing moves are more ominously contemptible than his restrictions on reading matter. Predictably, they contributed to a leap in cases of suicide from 30 in 2013 to 42 in just the first six months of 2014. No fewer than 23,183 incidents of self-harm occurred in 2013, a statistic in unabated expansion since the Conservative-Liberal Democrat coalition came to office in 2010. In an act of Oedipal horror, a prisoner at HMP Nottingham recently gouged out his own eyes. As highlighted by the chaotically violent Glen Parva in Leicestershire, a “toxic environment” in the estimation of the Howard League for Penal Reform, little effort is made to ameliorate conditions in young offender institutions. The Chief Inspectorate of Prisons found our local specimen, HMYOI Werrington on the outskirts of the Potteries, to be weak in preventing self-harm and bullying, but vigorous in conducting forcible strip searches.

At present, approximately 15% of this dismal gulag is privatized, but that will only increase when policy is steered by a mania to transfer public revenues – in this instance one flinches from saying “assets” – into private hands. It might have been assumed that scant leeway existed for an aggravation of conditions, but corporate involvement is demonstrating otherwise. A cloacal purgatory of violence and illicit drugtaking in consequence of being placed at the tender mercy of Serco, HMP Doncaster, in advice offered by the Howard League’s Frances Crook that is sure to fall on deaf ears, “should no longer be left in the hands of a multinational which puts shareholders’ interests before public safety.” G4S, which also manages the lethal “security” apparatus guarding Israel’s West Bank settlements, obliges inmates at HMP Oakwood to wait five weeks for a mental health referral after slicing an astonishing £10,000 from the standard cost of a year-long prison placement; occurrences of self-harm topped 600 last year, in comparison to 56 at the similarly sized, state-run Wandsworth. Because insufficient profits beckoned, A4E has just unilaterally torn up its contract to provide education in London prisons as a participant in the Offender Learning and Skills Service (OLASS). Denied education, “offenders” are herded into menial and repetitive work as a super-exploited proletariat, in what amounts to a particularly obscene species of post-Fordist outsourcing. Average earnings are £8 a week. Unlike the riots that regularly erupt at private prisons, this is not hushed up as a dirty secret. On its website, which features encomia from legal aid despoiler Kenneth Clarke and the head of the Confederation of British Industry, G4S rhapsodizes as follows on the advantages of a literally captive labour force unencumbered by sick pay, holiday leave, trade union membership or the ability to strike: “We have a dedicated workforce with a variety of skills which can work around business’ needs with the minimum of bureaucracy.” No mention of a minimum wage, it is to be noted, but the definite assurance of minimal “bureaucracy” (i.e., workers’ rights). I.G. Farben and the ideologues of Arbeit macht frei could not have boasted of a rapport more unabashed in its amorality.

Prospects for enlightened reform are bleak. What is referred to in government circles as the “prison estate” – remove the first “e” from “estate” and you have an example of Freudian parapraxis – is, to borrow a phrase from the prison letters collected in George Jackson’s Soledad Brother, the most “terrible, ugly machine” the ruling class has at its disposal, and unlikely to turn prettier at a time of indurate political reaction. Georg Ruschke and Otto Kirchheimer, the forefathers of radical criminology, pointed out in their 1931 study Punishment and Social Structure that reforms are constrained by the “heuristic maxim” that, in order to deter crime, circumstances in prison must be grimmer than those endured by the “lower strata” of the working class in the outside world. As the labour market under neoliberalism is relentlessly degraded, and poverty deepens, correspondingly prisons can be expected to become sites of ever fiercer disciplinary coercion. Quite transparently, the objective is to decant into prison as many as possible of the scroungers, troubled families and feral underclasses (the various labels of priggish contumely are interchangeable), where surplus value can be pumped out of them under compulsion, or they can simply be forgotten about. They will be joined by mentally ill prisoners guilty of no offence save that of overburdening an NHS buckling under endless fiscal austerity. Meanwhile, corporate crime on a breathtaking scale goes unchastised, confirming Bertolt Brecht’s mockery of bourgeois notions of criminality – “robbing a bank’s no crime compared to owning one” – to be no less incisive today than it was in the age of the Wall Street Crash.

Fyodor Dostoyevsky, who had first-hand knowledge of the brutalities of Tsarist imprisonment, wrote in his 1862 novel The House of the Dead: “The degree of civilization in a society can be judged by entering its prisons.” Given what we know from the Stanford Prison Experiment of the implacable tendency of a carceral milieu to make rabid authoritarians of the jailors who control it, and abject victims of inmates, I would contend that a society disfigured by prisons has forfeited its claim to be considered civilized, even before factoring into the equation that prisons under capitalism have their raison d’etre in sustaining inequities of power and property. For prisons to have become moneymaking enterprises, and a repository for mentally ill people whose confinement is a source of profit, is monstrous beyond words. When we viewed the Panorama documentary, I was struck by the fact that the programme drew spontaneous cries of outrage from Pathways members. A situation readily perceived by the mentally “ill” as repugnant is, by contrast, regarded with equanimity by its political overseers, or reckoned by them to be not nightmarish enough. A section of the “normal” populace, moreover, revels in callow fantasies of battling “crime” – the ideological and socially constructed nature of which is rarely questioned – with retributive sadism. I was left wondering whether our whole codification of sanity is fundamentally askew.

The UK Independence Party, Disability and Mental Health

 

Disabled children cost the council too much money and should be put down.

UKIP councillor Colin Brewer

 

Four years of Conservative-Liberal Democrat coalition government have reduced the United Kingdom – insofar as, ahead of September’s referendum on Scottish independence, it is united – to a parlous state: afflicted by spiralling debt, mired in minimal growth camouflaged by a berserk housing bubble, and with a gross bifurcation between rich and poor growing more outrageous by the day. In the local and European Parliament elections of 22 May 2014, the lamentable response of a significant portion of the electorate (some 4.3 million voters overall) was to favour the UK Independence Party, a ragtag band of petit-bourgeois dunces huckstering the prejudices of chauvinist false consciousness as purported solutions to the crisis. In Stoke-on-Trent, on a low turnout of 23.32%, and taking advantage of a vacuum left by the decline of the fascist British National Party, UKIP garnered 17,165 votes, vanquishing the hitherto entrenched dominance of the Labour Party. It’s painful to record that the most progressive option on the ballot paper, leftist alliance No2EU, drew a miserly 177 votes, and that the Greens were outmatched by UKIP by a factor of ten to one.

Across the board, UKIP’s policies are a passel of hateful bigotries, typically bellowed out by puce-faced reactionaries who, had electoral success eluded them, might come across as more blimpishly comical than nefarious. By a large margin, most attention has been focused on UKIP’s hostility to immigration, and on its demonization of the European Union as an allegedly imperious origine du mal  (a not insubstantive charge, but one where the proposed cure of corporatist autarky is worse than the disease). Undeniably, these are the most consequential aspects of the UKIP project. As revealed by a recently published British Social Attitudes survey, indulgence of UKIP anti-immigrant propaganda on the part of the political class – hardly an anguishing exercise for Tories, and no insurmountable battle with conscience for right-wing Labourites  – has served only to rekindle racism and xenophobia. Ground has already been conceded on that front, and the results are unlikely to be pleasant. If we examine less publicized areas of UKIP policy, however, an equally noxious picture emerges. In this article, I’ll take a brief look at the Little Englanders’ perspective on issues of disability and mental health.

The UKIP manifesto for the 2010 general election called for segregated education – ghettoization into “congregate” communities in evasively abstruse UKIP  terminology – for children with learning difficulties. A committee of the Council of Europe has branded UK disability payments as “manifestly inadequate” in monetary value, but according to the manifesto they are too munificent, and should be slashed to the same beggarly level as Jobseeker’s Allowance. UKIP’s spokeswoman on disability, the golliwog-fetishizing Star Etheridge, has backed off from endorsing such flagrant cruelties, but still insists that the bromidic “red tape” of health and safety laws constitutes the chief barrier to disabled people finding work, while pitching withdrawal from the EU as a panacea for all of the difficulties encountered by the disabled community. Pinning down the opportunistic details of current UKIP disability policy is no easy task; suffice it to say that nothing good can be expected of a party whose website has reviled social security claimants as “a parasitic underclass of scroungers” who should be dragooned at the earliest opportunity into punitive workfare schemes (commencing with recipients of housing and council tax benefits, with no exemptions specified for the sick and disabled). Human rights legislation, of enormous utility to disabled persons, remains in UKIP’s sights as something to be swept away as mollycoddling nonsense.

UKIP members such as Godfrey Bloom are well known for their bovine misogyny, but some venture beyond mere bumptiousness into the realms of the genuinely sinister. Useful idiots like Star Etheridge, who are not repelled by any notion of humanitarian “do-gooding” – and are actually women in this ideological enclave of Kinder, Kuche, Kirche – comprise a semi-respectable veneer behind which lurk truly obnoxious characters. Colin Brewer, for instance, a former UKIP councillor in Cornwall, has advocated the euthanization of disabled babies. Such children, in his reckoning, are akin to deformed livestock, and are the offspring of parents who are “breeding like rabbits” due to a wanton plenitude of state support. (Brewer has a fondness for bestial analogies, which may have diverted him from reaching for the expression “useless eaters” as justification for his sentiments.) Geoffrey Clark, a UKIP candidate in elections for Kent County Council, is of an equivalent mindset, although he would limit the homicide to compulsory abortion in cases of Down’s syndrome and spina bifida. These archaic stances – Brewer, with his penchant for infanticide, would find himself more at home in ancient Sparta than contemporary Britain – are compounded by a fundamental antagonism to the NHS, with UKIP bent on accelerating the Tories’ privatization drive. Under UKIP tutelage, the NHS in any case would become unsustainable owing to the party’s commitment to a highly regressive erosion of the tax base.

With regard to mental health conditions, the sympathy of UKIP activists is strictly rationed. Star Etheridge let slip her philanthropic mask when she declared, no doubt after deep ratiocination, that “retard” ought to be considered more of a contextually permissible word than a universally proscribed affront to human dignity. Paul Clapp, a UKIP councillor in Cambridgeshire, casually employs “mentally ill” as a slur in his pettifogging quarrels with fellow council members. Attention deficit hyperactivity disorder (ADHD), in the view of learned contributors to the UKIP message board, is nothing more than “psychobabble” cunningly crafted to keep “lefties” in the public sector jobs to which they are not entitled. Homosexuality, on the other hand, certainly qualifies as a psychiatric infirmity in the estimation of Dr Julia Gasper, a UKIP parliamentary candidate in Oxfordshire. Addressing the readers of an online site for gays, she held forth in the following manner: “It’s a shame that most of you are completely mad and need to be sectioned under the Mental Health Act. Just ring up your GP, tell him your symptoms and ask for help.” She omitted to add that UKIP would like to see them, and other patients, charged for the privilege of consulting a GP. (Dr Gasper’s doctorate is in English Literature rather than medicine, though one would be hard pressed to divine it from her careless prose. Presumably she is not the most acute exegete of Christopher Marlowe, Oscar Wilde or E.M. Forster.) UKIP’s leader, oleaginous Thatcherite Nigel Farage, has declined to censure one of his MEPs, Roger Helmer, who rants in similarly delirious fashion on the theme of homosexuality as psychopathology.

To the enlightened mind, all of this must appear absurd, wicked and more than a little unhinged, not to mention replete with ominous historical precedents. The present author, Mark Conlon, not generally given to invoking supernatural assistance, will make an exception on this occasion. May a god help us – not the authoritarian Christian patriarch of UKIP imagining, but perhaps one decreeing the fate of political parties in accordance with the principle of quem deus vuit perdere, dementat prius – should the proponents of such grotesqueries ever be in a position to implement them.

A Dialogue with Dr Xenofon Sgouros

 

On 26 November 2013, the Pathways group was visited by Xenofon Sgouros, a consultant psychiatrist who hails originally from Greece, but who since 1998 has spent part of the year working in the British NHS. He kindly consented to answer our questions on psychosis and related mental health subjects. The present author, Mark Conlon, recorded the meeting on a laptop computer, and I’ve structured this article around the conversation that unfolded. The topics addressed are complex, and in attempting a condensed overview one thinks of Gustave Flaubert’s witticism about historians gulping an ocean and micturating a cupful. There may, however, be a role for the simplificateur as counter to the trend of academic specialization, of knowing more and more about less and less. I should make it clear that any factual inaccuracies in what follows are my responsibility, rather than in any way attributable to Dr Sgouros.

As preamble, Dr Sgouros talked about his attraction to psychiatry. The profession has a sometimes alarming history – whirling chairs, lobotomies, the bizarre “treatments” of Julius Wagner-Jauregg – and Ewen Cameron’s sinister experiments of the 1950s and 1960s, sponsored by the CIA’s MKUltra programme, prove it would be complacent to assume they all lie in a remote past. A figure like Charles Krauthammer, a psychiatrist who branched out from diagnosing mania to espousing a neoconservative doctrine of “unipolar” US imperial hegemony, is hardly one to inspire confidence in more recent practitioners of the discipline. It was thus good to be reassured that there are those drawn to psychiatry for honourable and commendable motives, out of a genuine desire to ameliorate, in an enlightened fashion, what Herbert Marcuse called the “unhappy consciousness” of modern society. Dr Sgouros identified his late teenage years as the time he became seriously fascinated by the human mind, by the “chemistry of the brain and human emotions.” He remembers that he was the one to whom his friends in Greece would turn for advice on girlfriends and other matters of the heart. (To interject a note of levity, the fact that he was a fan in those years of progressive rock is verification in my eyes that he is on the side of the angels.) After graduating in medicine, and not being enthusiastic about general practice, Dr Sgouros had to decide between specializing in neurology or psychiatry. He opted for the latter because of its diversity, psychiatry being “medicine but not only medicine” inasmuch as it is imbricated with the whole spectrum of human behaviour and culture.

For the benefit of Al, an attendee of our sessions who has not experienced mental illness, we asked Dr Sgouros for a thumbnail definition of psychosis. The query is not a straightforward one. In 1987, the American Psychiatric Association was forced to admit: “Despite extensive field testing of the DSM-III [the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the closest thing to a canonical text in psychiatry] diagnostic criteria before their official adoption, experience with them since their publication has revealed, as expected, many instances in which the criteria were not entirely clear, were inconsistent across categories, or were even contradictory.” The inflation of categories in the two subsequent iterations of the Manual (2000 and 2013) can only have thickened the disjunctive fog. Dr Sgouros applied an Ockham’s razor to the problem by asserting that, essentially, psychosis involves beliefs split off from reality, these being clung onto in spite of being very unrealistic: as he phrased it, “the total process of thinking is distorted and disjointed.” Al observed that, when the phenomenon is defined in these broad parameters, it is one to which no one is immune. Dr Sgouros strongly agreed, and spoke of a “continuum of severity” from transient paranoid thoughts, where even among his fellow health workers he would suspect anyone claiming to be free of such thoughts of dissembling, to full-blown psychoses impervious to rational refutation.

A new member of our group, Frank, raised the question of a “paradigm shift” in attitudes to mental health, away from the biological model that is the dominant clinical approach. The biological orthodoxy, in which life experiences tend to be minimized to “triggers” of underlying organic disease, has overshadowed writers such as Gregory Bateson and Frieda Fromm-Reichmann, and after them assorted exponents of antipsychiatry, who explained psychosis in familial and societal terms, and who sought, in the words of Russell Jacoby, “to indict, not absolve, a maddening society.” In reply to Frank’s curiosity as to whether the pendulum is swinging back, Dr Sgouros said that there had been a slight shift since the 1990s toward a “psychosocial” model, with psychological interventions enhanced over the past five to seven years, citing as an example the Improving Access to Psychological Therapies (IAPT) initiative, soon to be expanded to cover more severe illnesses like psychosis. He adjudged this a move in the right direction, stating that “we have all been influenced by our families” and not seeking to downplay the role of social factors. As a professional psychiatrist, he can’t dismiss the biological standpoint; while conceding the historical abuses against which the antipsychiatrists reacted, “terrible stuff” he witnessed first-hand when employed at a large mental hospital in Greece, he was guarded in his sympathy for a critique of biologism carried to an antipsychiatric extreme, remarking on the irony of R.D. Laing’s progeny having grown up to be anything but well-adjusted. When I brought up the name of Thomas Szasz, he confessed to unfamiliarity with the Szaszian arraignment of psychiatry as moralistic inquisitorial apparatus. (Not, I should add, that Pathways members are aligned with Szasz’s brand of individualist libertarianism, the shortcomings of which make it unsurprising he is championed by the Church of Scientology. We are no subscribers either to his travestying depiction of mental illness as manufactured myth, the acceptance of which would invalidate the existence of this site.) By way of mitigation, Dr Sgouros elaborated that he is suspicious of anything to which the prefix “anti” is attached. Unavoidably, this would encompass the Manichean dualism of an antipsychiatric enterprise echoing Szasz in its excoriation of biological psychiatry, or “psychiatrosis” as R.D. Laing mockingly pathologized it in a 1964 issue of New Left Review, as a fettering of dissent and nonconformism.

Frank was interested in the extent to which a conceptual shift of this sort might have created renewed space for the ideas of Sigmund Freud and Carl Jung (related but not identical, the pair having come to doctrinal blows in 1912 over Jung’s Transformations and Symbols of the Libido). Frank Sulloway, in his 1979 book Freud: Biologist of the Mind, contended that psychoanalytic and biological perspectives are not fundamentally divergent, but a cursory comparison of Freud’s conjectures with the Diagnostic and Statistical Manual of Mental Disorders – notwithstanding the infamous Freudian statement that “biology is destiny” –  reveals the epistemological bases of the two to be distinct. Ludwig Wittgenstein advanced a plenary dismissal of Freudianism as mythology, while Theodor Adorno polemicized that “In psychoanalysis nothing is true except the exaggerations.” (Adorno was not above the odd exaggeration himself, writing in Minima Moralia that the “morbid scission” of psychosis arose from the permeation of human minds by the “radical objectification” of the capitalist division of labour.) Todd Dufresne’s vituperative Killing Freud pulls no punches in characterizing psychoanalysis as “a serious menace based on a top-heavy theoretical edifice, faulty premises, circular and self-validating arguments, methodological laxity, motivated self-deception, bad faith and lies piled upon lies for more than a century.” Dr Sgouros was far more measured in his assessment, declaring that Freud’s notions, of the unconscious, the ego and so on, had become so entrenched in our cultural belief system as to be beyond simple eschewal. He held that psychodynamic therapies derived from them, such as cognitive behavioral therapy, are helpful, while noting that the core principle of CBT was arrived at centuries before Freud by Zen Buddhism and the Stoic philosopher Epictetus. In Dr Sgouros’s judgement, psychoanalysis itself should be considered outdated as a treatment.

Freud’s celebrated case studies were of neuroses rather than psychoses, and his acquaintance with the latter was not extensive. He described psychosis as a disavowal of reality, an “active phase of remodelling” of the ego. It is unclear whether his adamantine pessimism, which interprets psychological disturbance as the price extracted by culture for a denial of instinctual drives – the argument of Civilization and Its Discontents, a 1930 tract of Spenglerian gloom – offers much hope for the banishment of psychotic conditions, as opposed to a less ambitious transmutation of neurosis into commonplace unhappiness. Freud believed schizophrenics, like sufferers of acute melancholia, to be incapable of forming the bridge of “transference” required of the analysand – or, to frame it in less dryly technical language, deemed them insufficiently deferential to the psychoanalytic maître a penser – lending weight to Michel Foucault’s charge that psychoanalysis “has not been able, will not be able, to hear the voices of unreason.” He admitted to fear and dislike of them, though holding out the possibility that refinement of the “talking cure” might remedy the situation. A two-week trial period of analysis was recommended to screen out seemingly neurotic patients who were actually psychotic. Freud’s contemporary, the psychiatrist Karl Jaspers, took a comparable view, writing in 1913: “The most profound distinction in psychic life seems to be that between what is meaningful and allows empathy [i.e., neurosis] and what in its particular way is ununderstandable, mad in the literal sense [psychosis].” Subsequent analysts, such as Silvano Arieti, have adopted a more optimistic stance. They have also, thankfully, revised Freud’s bigoted contention that the disavowal of reality in psychosis relates to – in Freudian jargon, is a “paranoid projection” of – repressed homosexual urges, an idea developed out of a misreading of the memoirs of German judge Daniel Paul Schreber, a man Freud never met. Unfortunately, for those reliant on the NHS, the matter is more an economic than a disinterestedly scholastic one. “Free association” does not come free in the monetary sense, and depth psychology (which may be “interminable” in Freud’s 1937 formulation) will lose out at a time of “evidence-based” financial stringency to the quick fix of medication.

Dr Sgouros acknowledged an intellectual debt to Jung, disclosing he had a “personal liking” for Jungian approaches, albeit more from a philosophical than a therapeutic angle. I broached the issue of Jung’s right-wing politics, his faith in a revolution (“an outburst of a new spirit”) inaugurated by Hitler in 1933, less pusillanimous and careerist than Martin Heidegger’s adherence to National Socialism but a disastrous miscalculation by any reckoning. The fervour did not fully ebb until Kristallnacht in November 1938. Gerhard Wehr has him pegged as a “psychoanalyst foaming with fascism” in his 1970 Portrait of Jung. Marxist philosopher Ernst Bloch had no hesitation in issuing a similar rebuke. Immanent, ahistorical “archetypes” of personality and an inherited “collective unconscious” – shockingly split by Jung into Aryan and Semitic wings – are disturbingly congruent with Nazi ideology, and Erich Fromm gibed that Jung was a “necrophilious” character enamoured of death, a trait suggestive of the viva la muerte morbidity of fascism. Remembering that prominent anarchist Herbert Read drew inspiration from Jung’s texts, and that Frantz Fanon, while censuring Jung’s racism, deployed Jungian concepts in Black Skin, White Masks, possibly I am painting too negative a picture. It could be that the Swiss Philemon, to borrow the name of one of the purported archetypes, is sufficiently protean – an “avant-garde conservative” in Jay Sherry’s conflation of opposites – to license diverse interpretations. Dr Sgouros clarified that he holds no brief for Jung politically, arguing that he should be seen in the context of his times, and valuing him in the way he values Richard Wagner, as someone in whom diagnostic wheat – or musical worth in Wagner’s case –  can be separated from ideological chaff.

Jung’s corpus is littered with what to the present writer are embarrassing divagations into alchemy, astrology and UFOs, with reliance on discredited concepts purloined from Lamarck (acquired characteristics) and Henri Bergson (a vitalist animating spark, or “ghost in the machine” in Jungian terminology, whence the connectivity between Jung and New Age mysticism). Much as one may bewail psychiatry’s biological pretensions, and Dr Sgouros’s imprimatur notwithstanding, a headlong flight into occultism and bogus science is no alternative. Frequently, Jung’s epigones take up the irrationalist baton of the master and run with it: a representative work of secondary literature is Sallie Nichols’s Jung and Tarot: An Archetypal Journey, a title lurid enough to have one scurrying back to the “godless materialism” of Freud regardless of the latter’s prejudice against psychotic illness. Admittedly, one can’t help warming a little toward someone who, in contradistinction to Freud’s exhaustive (and exhausting) labouring of Jokes and Their Relation to the Unconscious, possessed the laconic self-deprecation to quip “Show me a sane man and I will cure him for you.” We should, furthermore, give Jung credit for taking issue, from his 1906 article ‘The Psychology of Dementia Praecox’ onwards, with a hidebound Kraepelinian conception of schizophrenia as an irremediable arc of declension; according to Freud’s biographer Ernest Jones, he aspired to be the first to achieve a cure solely through psychoanalytic methods. If we are to extract a useful approach to psychosis from Jungian mythopoeia, it might lie in seeing psychotic states as a “shadow” overwhelming the social façade of the “persona” as a prelude, in an optimal scenario, to better understanding of the self: in psychiatric parlance, “integrating” rather than “sealing over” the experience. Although the gnomic cast of his utterances makes it difficult to be sure, conceivably that is the import of Jung’s maxim that “Only what is really oneself has the power to heal.”

We touched on the wilder shores of psychoanalysis when I proposed Wilhelm Reich as a leftist corrective to Jung, and found Dr Sgouros to be surprisingly sympathetic to a figure who in mainstream psychiatric circles must appear as, to put it mildly, a heterodox thinker. He said that he’d been much influenced by Reich’s books in younger life. I second his approbation with regard to Reich’s work of the 1920s and 1930s, the period of the renegade psychiatrist’s association with Austrian social democracy and the German and Danish communist parties, which remains highly relevant in its dissection of the malice and authoritarianism of what Denis Healey, in an era of pithier politicians, dubbed the “sadomonetarist” mentality of the hard right. Unless one is a diehard Reichian, it’s hard to deny that in babbling about bions and cosmic orgone energy the inventor of the Cloudbuster later went completely bonkers, if I may be permitted to use such vulgar and insensitive language in this blog. By the stage we reach the preposterously named vegetotherapy, crankiness of theory and appellation are in perfect harmony, even if Reich’s psyche was not. In Freud or Reich?: Psychoanalysis and Illusion, a hostile evaluation of Freudo-Marxism from an orthodox psychoanalytic perspective, Janine Chasseguet-Smirgel and Bela Grunberger predictably allege that Reich was already psychotic at the time Freud repudiated him, while Paul Federn, Sandor Rado and even Reich’s daughter Lore weighed in with similar accusations. Be that as it may, the earlier materialist writings have, in my opinion, penetrating things to say about the ways in which psychosis might be engendered by patriarchy, the bourgeois family and other structures of repression, and how in turn, to quote Reich’s own words, “the schizophrenic form of psychic illness is regularly accompanied by illuminating insight into the irrationalism of social and political mores.”

Viewing the aetiology of psychosis as biological has gone hand in hand with seeing the appropriate treatment for it as a medicalized one of neuroleptic medication. Sara Cooper enquired whether there are drugs in the pipeline that would entail fewer injurious side effects than current versions, a pressing question for members of our group undergoing the “maintenance therapy” of long-term use. However potent one considers antipsychotics to be in damping down “positive” symptoms of hallucinations and delusional thinking, iatrogenic consequences (ones brought about by the drugs themselves) weigh heavily on the minus side of the ledger. Tardive dyskinesia, for instance, has been described as “one of the worst medically-induced disasters in history” (by Peter Breggin, in his 1983 book Psychiatric Drugs: Hazards to the Brain). D.G. Cunningham Owens, in A Guide to the Extrapyramidal Side-effects of Antipsychotics, devotes over 300 disquieting pages to detailing the dystonia, Parkinsonism, akathisia and other disorders that can result from the drugs, and he is a writer who situates them in the “first division” of pharmacological efficacy. The latest generation of antipsychotics, the “atypical” ones introduced in the 1990s, has not lived up to corporate hyperbole – or brazen propaganda, not to put too fine a point on it – in eliminating the risks, and in fact has thrown up further perils such as agranulocytosis. Since patents are still operative on these newer drugs, and they are immensely profitable, there is little incentive for the “medico-pharmaceutical complex” (as David Healy refers to these agglomerated “darlings of Wall Street” in The Creation of Psychopharmacology) to improve on them. Dr Sgouros was not able to provide much comfort on this question. He confirmed that what he termed a “boom” in new drugs in the 1980s and 199os had slowed markedly, with research and development budgets reduced, and only a few new types (e.g., Asenapine) emerging since then. I know from the advice he’s given me that Dr Sgouros is no advocate of medication as magic cure – he can’t, one might say, be convicted of membership in the cult of psychotropic soteriology – and it may be that he looks on this situation with a greater degree of equanimity than more medication-oriented colleagues.

We asked Dr Sgouros what he made of Paul Hammersley’s suggestion of childhood abuse as a generator of psychotic illness. This has been put forward as a “traumagenic neurodevelopmental” explanation by psychologist John Read, editor of the journal Psychosis. It is traceable back to the “seduction theory” for the abandonment of which Freud has been taken to task by Jeffrey Masson, Freud in his work on hysteria with Joseph Breuer having spoken of “psychic traumas” that were “mnemic residues” of sexual abuse. Paul Hammersley is especially insistent on an association between such abuse and auditory hallucinations of a persecutory nature. On the last occasion Paul visited our group, he drew us a schema of psychosis as a form of dissociation analogous to posttraumatic stress disorder (PTSD). Dr Sgouros, though he would add stress the influence of genetics to a greater extent than Paul, together with trauma in later life and additional factors such as substance abuse, agreed with him in saying that “trauma in early life plays a very important role.” In this as in other matters, we found Dr Sgouros to be open-minded about ideas of social causation that appear eminently commonsensical, if not blindingly obvious, but are overlooked by psychiatrists who cleave to a circumscribed medical framework.

In recent years it’s become apparent that hearing voices is not the sole preserve of psychiatric patients, but is widespread in the general population. Although impossible to quantify with precision, researchers such as Marius Romme and Richard Bentall suggest the ratio of diagnosed to non-diagnosed hallucinators may be in the region of one to ten. Research in the Netherlands showed that widowed persons often hear the voice of a dead partner, and that 6.2% of a sample of more than 7000 people had experienced hallucinations of a similarly benign hue. Dr Sgouros concurred that the phenomenon is not necessarily a symptom of psychopathology. Indeed, he was more charitable to those claiming to hear religious voices than an atheist like myself is inclined to be, rejecting a pathologization of what he called “spiritual experiences” and not discounting the possibility of communication with supernatural forces. He pointed out that a harsher judgement entails the medicalization of a large proportion of the human race, from Old Testament prophets onwards, and also a disdainful attitude – what relativists would deplore as “Eurocentric” condescension – to societies with different cultural traditions, such as South America with its shamans and spiritual healers. He saw the matter more as a pragmatic one of the way in which such experiences are integrated into a person’s life, whether to positive or negative effect. Rather than insisting on a dogmatic verdict, it may be best here to quote a line from George Bernard Shaw’s quizzical Saint Joan. In the play, when it’s put to her that the ostensibly divine voices she hears are fabrications of her own imagination, the character of Joan retorts: “Of course. That is how the messages of God come to us.”

Dominic Orosun asked Dr Sgorous to elucidate the connections between psychosis and personality disorders. He replied that he does not particularly like the term personality disorder, an “artificial concept” he sees as describing behaviours rather than personalities as such. He told us he had firmly opposed the intention of the previous government to lock up people labelled as having a severe and untreatable antisocial personality disorder that potentially endangered others, going so far as to say he “freaked out” when he heard about the measure. He stated that those with personality disorders are “certainly more prone to psychotic disorders” due their inability to cope with stress, which leads them to the creation of their own realities, the hallmark of psychosis. “Schizotypal personality disorder” appears in the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD), but not in its US counterpart referred to above, the Diagnostic and Statistical Manual of Mental Disorders (DSM). (“Narcissistic personality disorder” and “borderline personality disorder” are by contrast in the DSM, but omitted from the ICD. In the context of North America, the fons et origo of the “culture of narcissism” deprecated by Christopher Lasch, one can discern a certain logic to the inclusion of the former.) As the name implies, schizotypal personality disorder has elements in common with schizophrenia, such as ideas of reference. An attempt on my part to become conversant with the teeming inventory of personality disorders via a standard reference work, Hughes’ Outline of Modern Psychiatry, has ended in defeat, with the reflection that the taxonomic mania on display seems scarcely less obsessive than that of the conditions it seeks to catalogue. In this area, one can’t help wondering whether there exists a dialectic of madness.

Much emphasis has been placed in this blog on the interaction between mental illness and retrograde developments in politics (neoliberalism and austerity). I consider myself on firm ground in making the connection, which has been well established empirically since a 1958 New Haven inquiry finding people in the lowest sociological class (“unskilled, manual”) to be three times more prone to mental illness than those higher up the social scale (“business, professional and managerial”). A Swedish investigation into two million children born between 1963 and 1983 similarly showed a three-fold higher risk of schizophrenia among poorer ones, while a study from 2001 in the British Journal of Psychiatry indicates that children raised in poverty are eight times likelier to develop schizophrenia than those in more comfortable circumstances, and four times likelier to develop other types of mental illness. Suicide rates have risen to tragic proportions (upwards of 70 per 100,000 people) in countries of the former Soviet bloc ravaged by neoliberal shock therapy. Textbooks deal blandly with the question; in its chapter on schizophrenia, Hughes’ Outline of Modern Psychiatry disposes of the “prosaic” issue of “life events” in precisely two sentences. It was pleasing to find Dr Sgouros is more flexible on the matter than many of his peers, whose insistence on biological determinants has gifted governments an alibi for neglecting the relationship between mental health and deprivation (or “social exclusion” as they prefer to euphemize it, being unwilling to call a spade a spade). He voiced his disapproval of regressive changes to benefit rules, and readily assented that we are “social beings” shaped by our environment. He maintained that it’s “not rocket science” to perceive the causal chain linking mental illness with unemployment, homelessness and other social ills, and reminded us that this is still more evident in Greece than the UK, not helped in the Greek case by the “catastrophic decline” in medical services stemming from fiscal retrenchment.

I contemplated entitling this article A Socratic Dialogue with Dr Xenofon Sgouros, but decided that to do so would be overly precious wordplay. It’s nonetheless to be hoped that a famous line of real Socratic dialogue, about the unexamined life not being worth living, can apply in a modest way to our meeting with him. We attempted to probe some of the thornier aspects of the life of the mind – its Gordian knots, to succumb to the impulse toward classical references – and succeeded in reaching consensus on a number of points. We all finally were in accord that the manner in which a society treats its mentally ill, and its vulnerable citizens in general, is a reliable index of its level of civilization. At the time of writing, in an irrefutable demonstration that the diagnosis “narcissistic personality disorder” is not without applicability, it has emerged that £250,000 has been spent since 1995 on commissioning portraits and sculptures of our noble parliamentary representatives, including £10,000 on an immortalization of a dedicated persecutor of the poor and disabled, Iain Duncan Smith. The sum is equivalent to the annual running costs of the Bennett Centre, the local mental health resource closed down in 2012 on grounds of unaffordability. The inescapable conclusion, which I believe Dr Sgouros would share, is that in significant respects this society is less civilized than it would like to imagine.

Mental Health and the NHS: Is Marketization Unstoppable?

Foes of the NHS raise a hand to identify themselves

Dishonourable members of a Westminster cabal intent on making a killing from administering economic shock therapy to the NHS

 

All the measures dictated to us by the economic situation are to be implemented as a matter of emergency. This is so that the rich can continue to get rich while paying fewer taxes… so that everything which is public can be privatized, and thereby ultimately contribute not to the public good (a particularly “anti-economic” category), but to the wealth of the rich and the maintenance (costly, alas) of the middle classes, who form the reserve army of the rich; so that schools, hospitals, housing, transport and communications – those five pillars of a satisfactory life for all – can initially be regionalized (that is a step forward), then exposed to competition (that is crucial), and finally handed over to the market (that is decisive), in order that the places and resources where and with which the rich and semi-rich are educated, treated, housed and transported cannot be confused with those where the poor and their like struggle to get by… so that the mentally ill can be imprisoned for life… Such is the invariant truth of “change”, the actuality of “reform”, the concrete dimension of “modernization”.

Alain Badiou, ‘The Rebirth of History: Times of Riots and Uprisings’

 

The primary culprit for the UK’s economic malaise can be pinpointed with ease: a cancerous tumour of financialization metastasizing in the body politic. The state allowed deregulated banks and a lawless City of London to run amok with credit default swaps, collaterized debt obligations and all the other derivative-based financial weapons of mass destruction whose “metaphysical subtleties” would require the acumen of a second Karl Marx to unravel, turning a blind eye as bankers and traders piled up mountains of fraudulent “assets” – fictitious capital in Marxist phraseology – on the back of which they awarded themselves bonuses of eyewatering magnitude. When the duplicitous house of cards ineluctably collapsed, the political class chose not to arraign the guilty parties for their criminal legerdemain, but rather, in a staggering display of socialism for the rich, to compel a blameless citizenry to bail them out, conjuring up ex nihilo billions of pounds in “quantitative easing” to hurl into this black hole of revenue absorption. Instead of apologizing to the populace that had been corralled into providing largesse to brigands whose gilded lifestyles they could never hope to emulate, the Tory-dominated coalition that usurped power in 2010 colluded adroitly with right-wing media shills to stigmatize the poor, unemployed and sick among them as authors of the crisis. Supposedly, it was not the unfairly maligned banker who had placed a grievous strain on the Exchequer, but these canailles with their esurient demands for the bare means of subsistence (or “handouts” in the vocabulary of Toryism), not to speak of their defrauding of a “dysfunctional” welfare system, which surely dwarfed in scope anything perpetrated by the denizens of the Square Mile. Thus, they had to be punished by austerity measures that would take away their services, housing and welfare benefits – our gracious monarch, in her jubilee year of 2012, assented to a vengeful Welfare Reform Act, earlier railroaded through Parliament via the seventeenth-century chicanery of financial privilege, that abolished any statutory rights to support even for the most destitute of her subjects – regardless of the fact that there has been no example in history of such measures accomplishing anything apart from the retardation of economic growth and the aggravation of wealth polarities.

Utilising the mechanism of austerity, neoliberals hope to bring to a victorious conclusion their jihad, signposted by US Federal Reserve Chairman Paul Volcker’s 1979 declaration that living standards must decline, against the progressive gains of the post-Second World War historic compromise between labour and capital. The most important legacy of that compromise in the UK is the National Health Service. Because of its pivotal role in the lives of the great majority of the population, it has been a tough nut for market fundamentalists to crack, less vulnerable to the divide-and-rule tactics that have been effective elsewhere in undermining the institutions of what we might call capitalism with a human face. Even Margaret Thatcher balked at the pitched battle with doctors and nurses urged on her by fanatical advocates of the “unthinkable” such as John Redwood and Oliver Letwin, though for pragmatic rather than ideological reasons. In the dislocation brought about by austerity, neoliberals have grasped their chance to expedite what had been a frustratingly slow dismantlement of the free, universal-access service that blocked the “investment opportunities” to which business lays claim as its inalienable right, with the aim of transforming it into what public health professor Allyson Pollock dubs “NHS plc” in a 2004 book of that title. As KPMG’s Mark Britnell chillingly put it at a private healthcare conference shortly after the Conservative-Liberal Democrat coalition entered office, “The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.” Naturally, for exoteric consumption the objective of corporate pillaging is not stated so honestly, if at all, but cloaked in the noncontentious language of choice, reform and efficiency.

Despite its functionality for capitalism in reproducing a labour force capable of undertaking the work required of it, the NHS has always stuck in the craw of reactionaries as an excrescence of socialism disfiguring their free-enterprise ideals, all the more so in the age of globalized neoliberalism – “a programme for destroying collective structures which may impede pure market logic” in the formulation of sociologist Pierre Bourdieu – when every last nook and cranny of life is subject to commodification in an insatiable search for profit. Worse still, the founding ethos of the NHS mandates an allocation of funds for treatment of the elderly, patients with chronic and terminal illnesses, and others with little or no prospect of crossing the economic apartheid barrier to validation as “active” members of society, or in other words of toiling to augment the wealth and dominance of the exploiting class. The NHS, in its original conception, recognized the intrinsic “use value” of good health; but capitalists have no interest in that, only in its “exchange value” insofar as they can parlay the superior labour power (or “productivity”) of healthy workers into higher profits. No matter that, before being saddled with the cash-devouring bureaucracy of the “internal market” promoted by Tony Blair, and the fateful embrace in 1992 of ruinous private finance initiative (PFI) contracts, the NHS was more efficient than any system of privatized health care, and spectacularly more so than the grossly profligate US model that Thatcherites and drug companies drool over: privatized it must be, for the lower orders have had it too good since 1948 and, amid ruling-class alarm about the cost of socialized medicine potentially placing a drag on capital accumulation, are to be returned to their rightful station, one of precarious wellbeing and a decently early death when their usefulness is exhausted. No matter either that, across the board from utility companies to railways, privatization has been uniformly calamitous, not to say fatal, for the general public – as David Bennett of health quango Monitor argues, it has at least exposed “monopolistic, monolithic markets” to the “economic regulation” of corporate profiteers, so there is no reason why the NHS should escape with its non-profit complexion intact.

Members of the Pathways group are agreed that we are living out this dismal scenario at the sharp end. Appointments with psychiatrists and other specialist NHS staff have become few and far between, absurdly so for a collective with experience of psychotic episodes, severe depression, self-harm and attempted suicide. On the rare occasions when appointments are granted, we have been told that we must give advance notice of inability to attend of not less than forty-eight hours, on pain of expulsion from the system. It would appear that, in the eyes of NHS bureaucrats, clairvoyance is a byproduct of mental illness. Such “downsizing” of services can only cause dismay and distress. At the time of writing, a local woman from Newcastle-under-Lyme, Brenda Moult, has resorted to the desperate step of discontinuing medication for her diabetes in protest at neglect of her mental health needs on the part of South Staffordshire and Shropshire Healthcare Foundation Trust, whose Chief Executive Neil Carr roused himself from managerial torpor long enough to issue the mindbogglingly complacent statement that “we are dealing with this as appropriate, through our normal complaints procedure.”

An investigation by the Care Quality Commission has disclosed that Brenda Moult’s predicament is far from uncommon, with 46% of community care plans opaque to those for whom they were drawn up, and 23% out of date. At our meeting on 27 August, Dave Williams said that, in his observation, many people react by withdrawing into a “bubble” of optimistic passivity, adapting to diminishing services in the hope that the situation will not deteriorate further. As he added with unfortunate accuracy, since the government has gulled much of the population into acquiescence with its austerity agenda, it will not be inclined to call off the attack now. Dave additionally noted that the Tories’ strategy is not to allay but to fuel hysteria about undoubted NHS failings, and then peddle the non sequitur that these are beyond fixing under state auspices, so that services must be dissolved, farmed out to a “third sector” of charitable and voluntary organizations, or transferred to the private sector if they are to be “fit for purpose” (a mindlessly parroted mantra of bureaucratic cant). The latest ruse is to encumber struggling hospitals with “inspiring leaders” – doubtless those selected will epitomize the oxymoronic nature of the term – whose interference, given that the real solution resides in eliminating administrative parasitism altogether, will end in inevitable failure and land them on a fast track to oblivion or subjugation to corporate overseers.

In the NHS as a whole, a direction of travel is observable toward minimal, perfunctory facilities for “customers” unable to pay the fees – or, as a particularly ugly specimen of marketization jargon has it, engage in the “cost-sharing” – that will be demanded for a fuller array of treatments. This especially applies in England, as Wales, Scotland and Northern Ireland are more fortunate in possessing devolved assemblies that have legislated to place some brakes on market-orientated alteration of existing clinical practice. Section 75 of the 2012 Health and Social Care Act renders the goal explicit by signalling an abandonment of comprehensive provision in favour of health consortia determining how “appropriate” they consider the existence of individual services to be. In the perennially underfunded area of mental health services, it is difficult to see how much more minimalistic things can become, but no doubt apostles of the “small state” perceive ample latitude for contraction. Private medical insurance will be out of reach for most, increasingly so as wages continue to shrink and abusive zero-hours contracts proliferate, and in the euphemistic wording of a current Competition Commission report involves “consumer detriment” for those who can afford it – i.e., patients are ripped off to the tune of hundreds of millions of pounds a year by the three dominant companies in the field, BMI, Spire and HCL, which effectively constitute a cartel. The sick therefore will be caught between the Scylla of cursory, bare-bones treatment and the Charybdis of hefty overcharging. It is a dilemma familiar since the 1980s to inhabitants of African and Latin American countries under the diktat of International Monetary Fund and World Bank-sponsored “structural adjustment” programmes; the callous sociopaths who designed those programmes are now poised to inflict their morbid dogma on First World states. In a lower-tier service catering to the indigent, thanks to the secrecy decreed by “commercial confidentiality” clauses, it will be impossible for victims of botched procedures to obtain restitution for the harm that “outsourcing” of treatment has visited on them. Nor will the results be pleasant for NHS staff funnelled by Taylorist management techniques down the path of reduced autonomy and greater “efficiency” – that is, more onerous workloads – in a low-status sector akin to the US Medicaid ghetto.

The Pathways group has a new recruit who, soon after joining us, brought along recordings he’d compiled of mental health-themed television documentaries that both resonate with his own experiences and reinforce the remarks made so far. An instalment in BBC Three’s It’s a Mad World season, ‘Failed by the NHS’ was oriented around Jonny Benjamin, a man aged twenty-six with a diagnosis of schizoaffective disorder. He related his anger at encountering, while in the depths of suicidal psychosis during his time at university, an NHS doctor with nothing more constructive to offer than a bottle of Valium tablets, and another who rationalized the lack of an inpatient bed by superciliously questioning his need for treatment. The programme, as well as drawing attention to the deficient training of GPs in mental health issues, a shortcoming that must worsen as GP surgeries are annexed by the likes of Atos Healthcare and ex-Health Secretary Andrew Lansley’s private-equity benefactor Care UK, highlighted the inadequacy of accident and emergency departments for those presenting after having self-harmed. In an interview, Dr Nav Kapur, of Manchester University’s Centre for Suicide Prevention, maintained that guidelines are routinely violated in that half of suicidal attendees receive no psychiatric assessment at all, while those that do are frequently patched up and sent on their way under the distinct impression that they are a “burden” on the system.

One might flippantly venture to propose that the suicidal take their cue from disgruntled patients at Norwich University Hospital, and camp outside A&E departments in tents until they attract proper notice. A report by Paul Kenyon in the BBC’s current affairs strand Panorama, aired on 9 September 2013, clarified what is actually likely to happen to them. ‘Locked Up For Being Ill?’ revealed the widespread and habitual incarceration of suicidal people in police cells as agonizing hours pass – outrageously, the law permits an upper limit of seventy-two hours – in fruitless efforts to locate mental health teams and psychiatrists to assess them. In Hampshire, the focus of the report, at night just four psychiatrists are on call to serve the larger part of the county. Simon Hayes, Hampshire Police and Crime Commissioner, stated that initial data indicates that 45% of those detained in custody are mentally ill, while nationwide it’s estimated that 20% of police time is spent dealing with people who have psychiatric conditions. The police powers invoked, section 136 of the Mental Health Act 1983, specify that, apart from in exceptional circumstances, suicidal detainees must be held in a place of safety, but clearly there is nothing safe about an environment where one can bang one’s head to a bloody pulp against a metal door or force a plastic fork down one’s throat, and nothing exceptional about such incarcerations: over 9000 of them occurred in 2011-12, some involving adolescents no older than fourteen. The Inspector of Constabulary, Drusilla Sharpling, has deplored this criminalization of the mentally ill. On Panorama, Liberal Democrat Norman Lamb, Minister for Care and Support, earnestly lamented “a national scandal” but suggested that “joined-up” services, sans additional money or any restoration of the 17% of acute psychiatric beds axed over the past five years, would be sufficient to address the problem. Since the government he represents is fragmenting rather than integrating the NHS, his argument is disingenuous. Our group’s Sara Cooper judged as “very true” the woeful picture of negligence painted by Kenyon, and there was unanimity in our ranks that he in no way exaggerated the shocking reality of what in essence is imprisonment for ill health.

Our new member’s third recording dealt with a no less worrying state of affairs. ‘Diaries of a Broken Mind’ (again from the It’s a Mad World season) featured a number of young adults with conditions ranging from agoraphobia to anorexia nervosa and, of greatest relevance to us, bipolar affective disorder. Abby, in addition to demonstrating that a misconception of bipolar disorder as “split personality” can be shared even by one’s own mother, echoed a common theme of the inaccessibility of services, with remorselessly lengthening queues and the preponderant weight of support falling on family and friends. (Here, incidentally, lies the hard economic kernel of the otherwise inexplicable volte-face of David Cameron, a former associate of poisonous homophobes, on the question of the legalization of gay marriage: as the safety nets of execrated “welfarism” are pulled away, he intends that social unrest be headed off through partners and families, some of them grateful for having been granted at last the imprimatur of the state, stepping into the breach.) The regretful Norman Lamb, that soi-disant champion of the socially excluded in the curious guise of fiscal conservative, was on hand again to explain that his solution to the crisis is for the Health and Social Care Act to be interpreted as placing mental health on an equal footing with physical health, which sounds unexceptionable until one learns that this entails no increase in the overall NHS budget, but rather a decrease in funding of physical services in order to divert cash toward shoring up the crumbling edifice of mental health provision. A striking aspect of the programme was its young participants’ heavy reliance on psychiatric drugs, something which should be heartening only to the pharmaceutical companies that derive a significant proportion of their gargantuan profits from these chemical pacifiers.

Evidence collated by epidemiologists Richard Wilkinson and Kate Pickett affirms that the yawning inequalities spawned by neoliberalism impact gravely on mental health. Consequently, even if the NHS were to continue in its traditional mode, it would be overtaxed in trying to contain a flood of psychiatric disorders. Tragically, it has been substantially weakened already by the incursion of avaricious private providers like Serco, ERS Medical and Tory-donating hedge fund Circle – on course to consume a fifth of the budget, and aptly characterized by Green Party leader Natalie Bennett as “corporate bloodsuckers” – and the retrenchment ostensibly necessitated by the exigency of deficit reduction. In Devon, for instance, Richard Branson’s Virgin Healthcare, boasting vomitously of its “outcome-driven” priorities, has control of mental health services for children. Hardly anything has been done to avert a second financial crash that would furnish the smokescreen for delivering the coup de grace to the Bevanite NHS that, as tight-lipped politicians looked on, was feted, or more accurately commemorated, in Danny Boyle’s opening ceremony for the 2012 Olympic Games. Indeed, after being handsomely rewarded for their culpability in one disaster, bankers have every incentive to marshal their deadly arsenal of derivatives and restage it on a vaster scale. George Osborne, having deployed a contemptible mortgage-subsidy scheme (“Help to Buy”) aimed at stoking a speculative housing bubble, seems hellbent on hurrying the replay along. The Tories, should Osborne’s gambit keep them in office after 2015, will command the wherewithal to dismember the welfare state entirely, in line with an interview David Cameron gave to The Spectator magazine in August 2007 in which he announced a desire to follow the lead of US ultraconservatives in doing exactly that. Banks may be too big to fail, with Cyprus-style seizure of deposits the probable next step in plutocratic welfare entitlement. Mere human beings, on the other hand, whatever idealistic guff a Liberal named William Beveridge may have believed about protecting them from cradle to grave, can readily be left to founder, to shuttle between food bank, park bench and homeless shelter, with entrapment in a secure psychiatric ward or the prison-industrial complex their ultimate destination. After all, when capital is mobile and able to scour the globe for cheap labour, millions of workers in sound health find themselves surplus to requirements, leaving those with psychological ailments utterly disposable. Since Beveridge’s day, moreover, as David Cameron’s underling Nick Clegg has been anxious to demonstrate, Liberalism has become flexible in its convictions.

Contrary to the prognostications of Francis Fukuyama, whose Hegelian musings on the “end of history” were all the rage in the 1990s, in the post-Communist epoch we are living not in peaceable liberal democracies, but in illiberal kleptocracies at war with enemies without and within, of whom the mentally ill, and anyone else daring to think unconventionally, are one. Precisely at the juncture when NHS services are in flux, the quest for scapegoats to deflect responsibility for economic fiasco away from financial elites and political oligarchies, a generalized phenomenon but honed to a fine art in the UK, threatens to undo decades of painstaking anti-stigma campaigning and relegate psychiatric patients, together with immigrants, Muslim “extremists” and the “scroungers” and “shirkers” of welfare demonology, to a category of the despised Other. Research published in the Lancet in 2012 showed that, over the period of a year, one in four of them will fall prey to physical assault, a stark statistic not likely to be mitigated by the deterioration in the effectiveness and moral culture of the NHS. Retail giants Asda and Tesco, as reported in the news this week, have felt no compunction in resuscitating the most regressive stereotypes about mentally ill people, placing on sale repellent Halloween costumes caricaturing them as homicidal, straitjacketed lunatics. In a highly disturbing development, children as young as seven are to be screened for symptoms of mental ill health, which in the present political climate implies not a benign attempt to help those with genuine problems, but the medicalization of incipient rebellion against the school-work-consumer treadmill under such preposterous rubrics as “oppositional defiant disorder” (ODD), and the implementation of methods to induce more “compliant” – or, in Frankfurt School terminology, authoritarian – personalities.

In light of all that has been said above, it would be easy, and perhaps justified, to conclude in a melancholy key. No set of circumstances, however, is so forlorn as to merit despair: as German philosopher Walter Benjamin asserted in another dark period of history, “It is only for the sake of those without hope that hope is given to us.” The NHS was the product of prolonged and bitter class struggle, a victory for the British working class after hundreds of thousands of them – and millions of workers globally – had sacrificed their lives to defeat capitalism in its terroristic Hitlerian form. The Labour Party fulfilled its historical mission in founding it and the other organs of the welfare state, and since then, the Bennite interregnum notwithstanding, has been a busted flush in protracted retreat from social democracy, a redundancy diagnosed as early as the Gaitskellite 1960s in Ralph Miliband’s withering Parliamentary Socialism, a text from which his sons apparently learnt nothing. No illusions should be harboured about the capacity of today’s Labour politicians, technocrats almost to the last man and woman, to preserve their own creation. In the opinion of the present author, Mark Conlon, it can be saved only through a resurgence of proletarian militancy, in solidarity with the resistance of NHS employees to the degradation of their profession, that would amend the balance of forces in a way favourable to labour analogous to that which obtained after 1945. I think it unduly pessimistic to assume that the neoliberal state is so hegemonic as to preclude that happening, and would easily quash here any of the mass mobilizations that are acclaimed, even if the interpretation is erroneous, as manifestations of the popular will when they occur in Libya or Syria, but in a British context are anathematized as “criminality pure and simple” (the words following the riots of 2011 of our august Prime Minister, whose antipathy to crime is, to say the least, selective). Capitalism in its neoliberal variant, in spite of its advanced stage of degeneracy, may not have met its gravediggers yet. At some point, nevertheless, it assuredly will. When, to quote Walter Benjamin again, “political action explodes the continuum of history,” mental patients will have a place alongside other oppressed and marginalized people in fighting for a better world, one that should have equality in health care as an unshakeable principle.

A Black Friday for Mental Health in Stoke-on-Trent

The reception area of the Bennett Centre, photographed by Dominic Orosun on 19 December 2012, two days before the facility's demise

The reception area of the Bennett Centre, photographed by Dominic Orosun on 19 December 2012, two days before the facility’s demise

 

The poor are the powers of the earth, they have the right to speak as masters to governments that neglect them.

Saint-Just, 1794

 

Today, 21 December 2012, a Stoke-on-Trent mental health facility, the Bennett Centre in Shelton, has closed, one more piece of collateral damage in the unrelenting “austerity” war conducted by Britain’s capitalist ruling elite. Its disappearance has nothing to do with its efficacy in allaying mental distress, in which capacity it has been outstanding, and everything to do with the fact that its work is far outweighed in the balance of political priorities by welfare for bankers and corporations. The Centre was formerly the venue for our group’s gatherings, and all Pathways members have relied heavily on its help. On this inauspicious date, and with the year drawing to an end, we are thus impelled to reflect on the state of mental health in the Potteries, and in the United Kingdom generally. Our experiences are a microcosm of the national situation, which is undoubtedly one of accelerating breakdown and crisis. David Sweetsur has written a poignant elegy on the loss of the Bennett Centre, and readers are directed to his blog,  A Day in the Life, for an account of a final public meeting that was held in the building on 29 November. Its termination is senseless and shocking, though it would be wrong to say that we were blindsided by the development; rather, for some time there has been a grim inevitability to it, even as sham consultations on closure were revealing vehement opposition to the move on the part of service users and their families. Cognizant that democracy and popular sentiment play a negligible role in the governance of Britain – an archetype of Robert Michels’ “iron law of oligarchy” if ever there was one – we are not surprised to find ourselves divested of material means of aid, but plentifully supplied with verbal bromides illogically assuring us that no untoward results will flow from a dismantling of NHS infrastructure.

It is jarring to contrast this desolate reality with the pious hopes expressed by our Panglossian political representatives. A House of Commons debate on the topic of mental health was held on 14 June of this year, and broadcast on the Parliament Channel. The present author, Mark Conlon, should stress that he is far from being a devoted viewer of this televisual conduit of what Leninist phraseology would impugn – not unfairly, in the case of the Westminster legislature – as parliamentary cretinism. However, given the interest of the subject under discussion, I watched the session with a degree of care. The debate had been requested by two Conservative backbenchers, Charles Walker and Nicky Morgan. In arguing for its desirability, Walker, a self-described “practising fruitcake” and chair of the All-Party Parliamentary Group on Mental Health, pointed out to schedulers that it would be only the second discussion of its type to have taken place in his seven-year tenure as an MP, in itself a telling indication of the value placed on mentally ill people by Westminster’s compassionate legislators. Morgan was a corporate lawyer before becoming the representative for Loughborough in 2010, and has a dismal parliamentary record which did nothing to inspire confidence in her ability to initiate an enlightened interrogation of the issue at hand: she has voted for increases in VAT and university tuition fees, supports repressive anti-terror laws, and favours the austerity-defying replacement of Trident missiles with a more lethal nuclear armoury. She gave an introductory talk, which was followed by contributions from Walker and other speakers.

Let us be scrupulously fair to the participants, and to the bare handful of parliamentarians able to find sufficient space in their demanding schedules to attend the debate, and acknowledge its good points. A number of MPs were frank in talking about their own psychiatric problems, even if their intention of thereby combating stigma meets the impediment that politicians are scarcely the kind of esteemed figures likely to encourage the public to reevaluate prejudicial attitudes. Kevan Jones, a former Labour defence minister, revealed a hitherto suppressed history of depression, Conservatives Sarah Wollaston and Andrea Leadsom spoke of their experiences of postnatal depression and anxiety, and Charles Walker discussed his ongoing struggle with obsessive compulsive disorder: in “coming out” about their respective mental health diagnoses, all of them can be commended for summoning more courage than is habitually displayed by British MPs. Pertinent, if hardly revelatory, observations were made about drastic shortfalls in mental health funding, an excessive reliance on drug therapies, the unreasonable burdens placed on carers, the punitive nature of work capability tests, and the scandalous sentencing of the mentally ill to terms in prison. Positive changes have emerged from the debate in the form of legislation lifting bans on those with a record of severe mental illness from serving as jurors, MPs or company directors. The repeal of these antiquated laws is welcome, though it should be said that the advance is directly attributable not to government initiative, but to a private member’s bill put forward by Liberal Democrat Paul Burstow.

So much for the praiseworthy aspects. On the negative side of the ledger, we may note a relaxed and collegial tone to proceedings incongruent with the desperation of people’s lives outside the cossetted environs of the Commons debating chamber. Lacunae and begged questions were glaring, and as a tour d’horizon of mental health in the UK, Nicky Morgan’s exposition was clearly inadequate. Her hope that employers will rethink discrimination is utterly fantastical at a time when capitalists, in tandem with government, are engaged in an all-out assault on workers’ rights and wages (and, by taking advantage of the forced labour gifted them by workfare, on the very concept of wages). The one employer guaranteed to cater to the requirements of mentally ill people, Remploy, is having its factories systematically shut down, with thirty-four out of fifty-four already gone through a callous withdrawal of support by the Department for Work and Pensions. With a wholesale top-down restructuring of the NHS imposed in mendacious violation of Tory election pledges, and the example of the Bennett Centre in mind, Morgan’s call for a greater say for service users is likewise pie in the sky. No evidence was adduced that progress can be made in these directions in the context of an ever more exploitative, hierarchical and secretive polity.

In a speech delivered by a Tory, unsurprisingly there was no mention by Morgan of the governmental campaign of vilification directed against welfare claimants. According to a recent poll carried out for the Daily Telegraph, this has diminished public backing for the benefit system to its lowest level for thirty years, an outcome with deplorable implications for those mentally ill persons compelled to rely on welfare payments. A previous crisis of capitalism, that of the 1930s, was triggered by untrammelled financial speculation and seized upon by hateful politicians as an opportunity to scapegoat and persecute the vulnerable. In their venomous contempt for the sick and disabled, many of Morgan’s colleagues are cut from the same social Darwinist cloth, and desirous of making destitution via Atos assessment a mere prelude to something more sinister, along the lines of historical precedents branded by Antonio Gramsci – a man with serious disabilities of the sort regularly “cured” by the thaumaturgy of Atos doctors – as “incredible acts of brutality which have cast the weak and the non-conforming into the limbo of the lumpen-classes or have eliminated them entirely.” Of the lessons to be learned from history, the slide in Nazi Germany toward Aktion T4 is one of the most vital. It commenced with caricatural demonization of the disabled in right-wing propaganda organs, such not-so-distant cousins of The Sun and Daily Mail as Neues Volk and Der Angriff, emphasizing the cost to the state of prolonging the Ballastexistenzen of useless human beings. Certain Tories, to their shame, regard this descent into the abyss more as exemplar than harrowing warning. Already the consequences have been fatal, with non-productive “stock” – investment banker and welfare “reform” minister Lord Freud’s vile characterization of those whose existences he controls – fraudulently stripped of entitlement to sickness benefits, then robbed through arbitrary “sanctions” of Jobseeker’s Allowance, and finally driven in despair to suicide.

Consistently, debators ignored the certainty that an increasingly inhumane and reactionary society will only exacerbate psychiatric distress. Several speakers adverted to the damaging effects of inferior accommodation on mental health, but in a vacuum where “bedroom taxes” and benefit caps went unremarked. Homelessness is hugely corrosive of mental well-being, yet no remedies were proposed for a predicament in which 200,000 households were at risk of eviction or repossession in the period from October 2011 to September 2012, and 75,ooo children will spend Christmas 2012 in temporary housing. Examples could be multiplied, but would not modify the pattern of willing a leap into utopia in the absence of the social conditions to enable it. Who would have guessed that the denizens of Westminster are so sympathetic to ultraleft voluntarism? From the perspective of our group, the most obvious elision in the debate concerned psychosis, to which only passing reference was made. In the further interest of fairness, it should be conceded that Charles Walker addressed this failing in a House of Commons session he oversaw on 10 December, a response to the publication in November of The Abandoned Illness, a Schizophrenia Commission report recently analyzed by Dave Sweetsur in his blog. Much like its predecessor of 14 June, however, it was full of noble intentions that will come to grief when confronted with an NHS withering under “austerity” cuts, and offering the likes of Capita and KPMG limited scope for harvesting of profits by privatization of the “cinderella” service of mental health provision. The NHS budget of £100 billion represents lucrative pickings for corporate raiders overall, but only morsels can be pilfered through usurping the jobs of those tending to an economically deprived stratum of patients. The upshot will be a proportion of such jobs vanishing, with the remainder in a sectoral backwater without the resources to dam the rising tide of mental suffering. Schizophrenic “customers” may be the recipients of Walker’s orotund speechifying on the floor of the House of Commons; they are unlikely to receive much in the way of professional care. The bad faith of Tories who pontificate about a brighter future for the mentally ill, while knowing very well that a bleak fate awaits them in a commodified NHS, is breathtaking.

Adjectives such as “historic” and “landmark” have been bandied about by commentators on this episode of parliamentary loquaciousness. That is surely hyperbole, as the speeches amount to little more than amateur marginalia to arguments about mental health. Meanwhile, the recommendations of experts in the field, together with the opinions of mentally ill people themselves, are routinely brushed to one side because they conflict with the dogmas prized by the political class. What Nicky Morgan’s approach essentially boils down to is this: let’s encourage those in positions of power to be a little nicer and more understanding, and things might improve for the mentally ill. Unfortunately, this wishful thinking founders when it runs up against the sort of society her party is shaping: one in which the powerful ride roughshod over the powerless in an unbridled pursuit of wealth and privilege. It would be the sheerest fantasy to expect the government to which she belongs to row back from widening the grotesque social divisions that contribute to mental ill health. With its abandonment of even the pretence of pursuing social democratic reformism, nothing better can be expected of the Labour Party should it regain office. Neither party has the least degree of sympathy with the contention of Saint-Just, quoted at the head of this article, that a country should be governed in accordance with the preferences of its poorest and most distressed citizens. In the eyes of Tories and Blairites, latter-day Burkeans contemptuous of those in “unwholesome and pestiferous occupations” – or, worse, no occupation at all – such ideas are to be anathematized as affronts to their divinely mandated authority to dictate the conduct of the lower orders. In a class-riven society managed by these parties, regardless of whether they are propped up by amoral Liberal Democrat careerists, the prospect for the amelioration of mental illness is dire. Rather than rely on the benevolence of zealous promoters of the neoliberal state that perpetuates their misery, mentally ill people would do better to join in solidarity with other oppressed groups seeking that state’s complete overthrow, and its replacement with one predicated not on the inhuman pursuit of profit, but geared instead to the fulfillment of human needs and happiness. After decades of massive wealth transfer from poor to rich, and with a cruel Welfare Reform Act reducing swathes of the poor to corporate helotry or absolute pauperization, not to speak of rendering many of them psychologically ill in the process, revolutionary change could not be more imperative.

I will conclude with some reflections of Pathways group members on the Bennett Centre and the people who worked there, gathered during a meeting at Hanley library and our subsequent Christmas meal at the China Garden carvery. Sean described its staff as “brilliant” at ensuring a safe environment for service users. Dave Williams echoed his view in speaking of the Centre as a lifeline and a safety net, staffed with people he could trust, singling out Anita Thomas for particular praise. He lamented what he termed “the destruction of a useful service.” Sara seconded Dave’s high opinion of Anita, and recalled how the Centre had come to her rescue when she had been homeless in 2008. She cherishes a vivid memory of Matt Aitken cooking a meal for her when the two of them were inpatients. Because of their untimely deaths, Matt and Cath Barker will be uppermost in my mind when I think back on the Bennett Centre, but I would also like to pay tribute to all the members of staff I’ve known, especially Sue Mellor, Janet Sigley, Colin Burgess and Nigel Faulkner. When I was an inpatient in 2002, Sue, having calibrated my political outlook with precision, lent me her own paperback copy of John Pilger’s Hidden Agendas. I was too unwell to read more than a small portion of the book, but those few pages contributed to reestablishing a tentative connection to the world outside the confines of my psychological anguish. It was such small gestures of kindness, repeated on a daily basis, that made the Bennett Centre so effective in its work, kindnesses which are beyond the comprehension of conservative ideologues and bureaucratic number crunchers. Working with people who were often at the limit of their endurance, in a culture whose ethos is harshly inimical to those who fall outside the psychological norm, its dedicated staff excelled in restoring to them dignity and self-belief. Above all, I have the Bennett Centre to thank for placing me in contact with the members, past and present, of the Pathways group, each of whom has demonstrated qualities of fortitude that make a nonsense of every negative stereotype about mental ill health.

Our Thoughts on Improving Mental Health in the Potteries

In the course of one of its recent meetings, the Pathways group discussed with Dawn Lindop the challenges posed by mental ill health in Stoke-on-Trent. Dawn is a student nurse engaged in research on this subject, and she wanted to canvass the views of the group on possible strategies for the amelioration of mental distress in Stoke.

The Pathways group was united in its view of the Potteries as an area suffering from considerable economic and social deprivation, with some acute problems of mental ill health arising from this. There was unanimous unease about the exacerbating impact of current government austerity cuts on this already serious state of affairs. Group members were worried about the threat of withdrawal of services and benefits on which they rely, with closure of libraries and swimming pools, and tighter criteria governing eligibility for bus passes (discriminating in an insensitive manner against mentally ill applicants) among matters raised.

Subsequent research has shown the group’s impression of their city to be an accurate one, and their concerns about a deteriorating outlook to be well founded. A recent document issued by the Royal College of Psychiatrists, No Health without Public Mental Health: The Case for Action, states that mental ill health “is consistently associated with deprivation, low income, unemployment, poor education, poorer physical health and increased health-risk behaviours.” Sadly, Stoke-on-Trent scores heavily on this list of negative contributory factors. For example, 14% of the area’s people are unemployed or unable to work (2009 figures), 23% lack any educational qualifications (2008 figures), and a huge 46% of private households are classified as being in fuel poverty (2009 figures). One positive aspect is that disparity of income between rich and poor is lower than the national average, due largely to the relatively small number of affluent professionals living in the city, such inequality being recognized as a crucial generator of mental illness. Overall, nonetheless, the picture is an unencouraging one. As for concerns about worsening conditions, at the national level the Conservative-Liberal Democrat coalition has launched an assault on services (supposedly to be replaced by an ill-defined and nebulous “Big Society”) and a purported “benefits culture” which, if it exists outside the realm of right-wing fantasy, delivers decidedly ungenerous sums of money even to those diagnosed with mental conditions of a severe and long-lasting nature; while at local level, Stoke-on-Trent city council will be compelled by the draconian Comprehensive Spending Review unveiled in October of last year to make cutbacks on the order of some £40 million annually, with inevitable harm done to vulnerable sectors of society such as the mentally ill. Indeed, such cutbacks have already been seen in a reduction of beds in the inpatient “bungalow” part of the Bennett Centre (the building in which the Pathways group meets), and in a marked diminution in the range of educational courses available to users of mental health services.

This rather bleak scenario notwithstanding, the members of our group had no shortage of ideas for ways to combat existing mental ill health and fight back against any degradation in conditions unjustly inflicted on mentally ill people in the name of an economic crisis the latter had no hand in engineering. As a point of general principle, they were adamant that service users are entitled to a say in whatever changes are made in mental health provision, rather than these simply being imposed from above in an authoritarian or paternalistic fashion.

The group contended that those attempting to cope with the onset of mental ill health should be made aware of a wide range of sources of help. These, they suggested, might include general practitioners, libraries, the Samaritans, the internet, practitioners of complementary therapy, and, not least, service users who have undergone similar experiences. A proposal for better signposting of such resources was for displays and information packs in libraries, tourist centres, and supermarkets and other retail outlets. It was pointed out by one group member that Hanley’s large new Tesco store would provide an excellent venue for an information stall of this nature. Funding for “freebies” such as pens might be sought as an effective means by which to promote this kind of educational material. It was noted that, in the pursuit of an educational strategy of this sort, the Pathways group possesses valuable assets in Dominic Orosun and David Sweetsur: the first a competition-winning photographer able to supply relevant photos; and the second a published author with extensive knowledge of the conjunction between mental illness and the media.

Education of young people on the topic of mental health was seen by the group as highly significant, particularly in combating the emergence of stigmatising attitudes, and it was recognized that this might best be done at appropriate times of day (between, say, 3 and 6 p.m. in term time, or at weekends and during school holidays). Mothers’ and carers’ groups might also be approached, as these contain persons prone to mental disorders such as postnatal depression and stress brought on by lack of respite from caring for others.

Some members of the Pathways group have had a fruitful association with the local Lifestyle Project in terms of eating more healthily and taking exercise, and it was thought that, given the holistic interrelationship between physical and mental wellbeing, liaison with this organisation might be of benefit to many with mental health problems, notably those who have gained weight as an unwelcome side effect of taking psychiatric medication. It was mooted that the possibility of interviews on local radio stations might be investigated as a means of disseminating accurate information on mental health, as a counter to the often prejudicial stance on mental illness adopted by the media. Finally, it was suggested that NHS spokesperson Anne McGregor and Bennett Centre manager Sue Mellor be consulted for their views on the applicability of the strategies outlined here.

Making comparison with the position statement of the Royal College of Psychiatrists referred to above, there is a striking congruence between its recommendations and those arrived at by the Pathways group. To take one example, No Health without Public Mental Health draws attention to the fact that half of all mental illnesses have already manifested by age fourteen, and that as a consequence early education and intervention is very efficacious, with a cost/benefit ratio of 1:6. Since the UK currently languishes at the foot of league tables measuring children’s happiness, the thinking of our group in this area is especially apposite. In conclusion, then, it can be said that this convergence of opinion between service users and mental health professionals illustrates that the former, by virtue of their direct lived experience of mental illnesses and their effects on everyday life, have great insight into what needs to be changed in the wider society to make those illnesses, during the time they persist, less burdensome, while simultaneously enhancing the likelihood of ultimate recovery.