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.


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.

An Excursus on Ralph Miliband

The young Ralph Miliband flaunting his hatred of Britain through enlistment in the Royal Navy

“Daily Mail” founder Harold Harmsworth posing with the sort of political thinker favoured by his class over men of Ralph Miliband’s disreputable stamp











As the history of our century has proven since the beginning of the debate between “reformists” (or gradualists) and “revolutionists” inside the socialist movement – since the inception of Bernsteinian revisionism – the real issue is not whether revolutions are “advisable” or “bad” (‘the embodiment of “evil” and moral sin’ as the German SPD chief Friedrich Ebert thought). The real issue is whether they inevitably occur again and again, because the contradictions of bourgeois society – economic, social, political, military, cultural, even moral ones – periodically sharpen.

Ernest Mandel, ‘How to Make No Sense of Marx’, 1989


In the previous article on this blog, the present author, Mark Conlon, made reference to the less than encouraging pointers to be found in the writings of Marxist political scientist Ralph Miliband (1924-94) as to the likelihood of the British Labour Party, bearing in mind that party’s crippling adherence to what Miliband castigated as the constitutionalist and de-radicalizing ideology of parliamentarism, mounting a successful defence of the National Health Service and the Welfare State against attack from the neoliberal right. The day after I published the piece, by coincidence a media furore blew up over an attempt by Daily Mail hack Geoffrey Levy to smear Miliband’s son, Labour leader Ed, by associating the child with the purported sins of the father, who had been slandered in the Tory propaganda sheet as a man whose “socialist” – the word was mysteriously placed in quotation marks in Levy’s diatribe – convictions meant he unambiguously “hated” his adopted home of Britain. Of particular horror to Levy was a diary entry made by the seventeen-year-old Ralph Miliband critiquing the Francophobia and overweening nationalism of his insular hosts. According to Levy, presumably with Mail editor Paul Dacre guiding his chauvinistic pen, Miliband pere was additionally guilty of such foul deviations from human decency as dislike of the Windsor monarchy, the Church of England, the House of Lords, public schools, Oxbridge, and the UK’s glorious armed forces. The last allegation was ventured in spite of its target, a Jewish refugee from the Nazi conquest of Belgium, having served between June 1943 and January 1946 on Royal Navy warships after the British government granted him asylum (an offensively philanthropic concept of which the Daily Mail strongly disapproves). At the time of writing, the row is still rumbling on, with accusation and counteraccusation flying back and forth as the Mail strives to limit the damage done to its reputation – in tatters already for anyone who abjures philistine bigotry – by what is proving to be a miscalculation on its part of the degree to which it can debase public discourse.

In this pale rerun of the Zinoviev Letter plot, a manoeuvre to derail Ed Miliband’s prime ministerial bid through the laughable imputation that he is as passionately left-wing as his father, the charges levelled that the latter was a devotee of an “evil” communistic creed, one authorizing the worst excesses of Stalinism, are too rote and hackneyed to merit extensive reply. Ralph Miliband consistently derogated Leninist vanguardism and its belittlement of “formal” bourgeois freedoms, and his political allegiance, in terms of party membership, never extended further leftwards than the Labour Party of the 1950s, which had about it no detectable odour of brimstone. Similarly, it is almost too obvious to point out the absurdity of the Daily Mail throwing stones in the glass house of patriotic fervour, considering the newspaper’s past predilection, excepting the occasional hurrah on behalf of Oswald Mosley, for Mussolini and Hitler over homegrown politicians – an admiration the fascist foreigners reciprocated – and the non-domicile status of its present chairman the fourth Viscount Rothermere, whose abhorrence of the crown exceeds that of the late Professor Miliband inasmuch as, despite having at his disposal a personal fortune of £1.02 billion, he declines to donate a single penny in tax to Her Majesty’s Revenue and Customs. Should anyone wish to suggest, meanwhile, that things have moved on since the 1930s, and that Mail journalists should not be prohibited from criticism of Miliband because he was on the right side of the antifascist struggle when the publication for which they work was not, let’s not forget that Rothermere’s lackeys continue to cultivate a keen interest in fascism, recommending a vote for Marine Le Pen – not entirely flawless in ideological disposition, but the sole “responsible” candidate according to pricelessly named Mail scribbler Richard Waghorne in the French presidential election of 2012, on account of their displeasure at Nicholas Sarkozy’s excessively moderate policies, or fidelity to “muddy centrism” as Mr Waghorne astonishingly perceived it.

As hinted at by the quotation at the head of this article from Miliband’s compatriot, Marxist comrade and almost exact contemporary Ernest Mandel, the question that should be addressed, and which is more interesting than inquiring into the predictable hypocrisy of bourgeois scribes, is not the infantile one of whether Ralph Miliband was “evil” in avowing Marxist beliefs, and was a firebrand who sought to actualize those beliefs through the kind of workers’ revolution that, in the conspiratorial universe of Daily Mail ignoramuses, would never discomfit their cosy equilibrium unless fomented by wicked left-wing agitators. Rather, it is whether the writings informed by those beliefs yielded accurate, objective analyses of the topics under examination. Early indications are that sales of Miliband’s books, and of Michael Newman’s 2002 biography, Ralph Miliband and the Politics of the New Left, have been boosted in the wake of the Daily Mail ruckus, a condign lesson for Mail propagandists in the dialectics of unintended consequences. Purchasers will be in a position to judge for themselves how discerning Miliband was in his characterization of the world in which they live. The startling accuracy of his diagnosis of the British state, and the ways in which that perspective elucidates the NHS – an institution currently in the throes of privatization at the hands of brutish reactionaries the Mail hopes with its sordid contrivances to keep in office – can briefly be dealt with here. It will be noted that I say British state, as I don’t propose to waste time ruminating on “Britain” in the theological sense beloved of nationalistic journalists, an immaterial abstraction Miliband undeniably scorned, from his adolescent deploration of British xenophobia onwards. I ask other members of the Pathways group to forgive my indulgence. As someone who was an admirer of Ralph Miliband long before I was aware of the existence of his strangely destined sons, it’s a temptation I find impossible to forgo. In discussing the NHS, I’ll endeavour to keep the detour tolerably relevant to the concerns of this site.

Miliband was a defender, notably in a celebrated (relatively speaking) polemic in New Left Review with Greek structural Marxist Nicos Poulantzas – Argentinian writer Ernesto Laclau, at that point a sympathizer of Poulantzas rather than the post-Marxist flayer of “economism” he became, was also embroiled in the dispute – of an instrumentalist conception of the state as a weapon of class rule, as crystallized in such classical Marxist iterations of the theme as “the executive of the modern state is but a committee for managing the common affairs of the entire bourgeoisie” (Karl Marx, Friedrich Engels, Communist Manifesto, 1848) and “the modern representative state is an instrument for exploiting wage labour by capital” (Engels, The Origin of the Family, Private Property and the State, 1884). For the sake of readers unsympathetic to Marxism and/or longwinded academicism, I won’t expound in detail the abstruse debate, which saw Miliband stretching scholarly politesse as far as charging his interlocutor with “hyper-theoretical” errors embedded in a “formalized ballet of evanescent shadows.” Suffice it to say that Parliament under David Cameron’s premiership, with its singleminded devotion to advancing the interests of the “wealth creators” lionized by representatives of all major parties, might have been carefully designed to refute the objection of Poulantzas – who committed suicide in 1979, conceivably in despair that all his arduous Althusserian theorizing had failed to prevent the accession of Margaret Thatcher – that the quoted loci classici of Marxian analysis are overly reductive in downplaying the autonomy of the state, and exaggerate the stranglehold of regulatory capture, to use a contemporary term, that the capitalist class has over the state apparatus. Nor would Miliband, a student of Antonio Gramsci’s theory of hegemony, have been surprised to discover Cameron’s extreme partiality toward “entrepreneurship” shrouded in “commonsensical” proclamations of the universal beneficence of a corporate imperium, as something serving, in a phrase that drips readily from the Prime Minister’s casuistic lips, the “national interest” of all sections of society.

Westminster conforms closely to Miliband’s description, in his 1969 book The State in Capitalist Society, of bourgeois states as presided over by elites who are “dedicated servants of their business and investing classes.” When Cameron speaks of “recovery” being on the horizon, he does not mean that state services like the NHS are in prospect of being restored to their former vitality, still less that ordinary people will recover the standard of living snatched from them by recession and austerity, a matter of supreme unconcern to an Old Etonian and alumnus of the Bullingdon Club, but is voicing the rather more partisan hope that his class will recover its power of accumulation to the greatest possible extent, as reflected in profit margins and stock market valuations. Now that they have ditched a commitment even to the timid, ad hoc brand of reformism (dubbed “Labourism” by Miliband) symbolized by Clause IV, and jettisoned with indecent haste the anaemic substitute of Anthony Giddens’s Third Way, Labour politicians are scarcely differentiable from Cameron in outlook, while Liberal Democrats can congratulate themselves on the most astounding surrender to capitalist values witnessed in British politics since Ramsay MacDonald’s perfidy of 1931. Miliband’s perception need be qualified only in that the Westminster oligarchy is nowadays less biased toward its own business class as compared with overseas competitors, having undergone an ardent conversion, heedless of the violence done to its professedly jingoistic principles – “British jobs for British workers” in an unfathomably dense emanation of Gordon Brown’s clouded brain – to hiving off huge chunks of the economy to transnational capital (Royal Mail, the UK’s venerable postal service, is the latest heirloom of family silver to be unpatriotically auctioned to the lowest bidder). Thus we can conclude that Miliband’s reservations about the parliamentary democracy enshrined in the British state, a scepticism so righteously denounced by the Daily Mail – which no doubt is organized internally on a highly democratic basis from hereditary owner Lord Rothermere downwards – had nothing to do with a rejection of democracy per se. They were founded on his recognition that parliamentary democracies function to stymie genuine participatory democracy from below, to block the emergence of what Miliband called a “dual power” alliance between state and grassroots organizations, in order to perpetuate an entrenched ruling class and ward off any threats to the sovereignty of business, i.e., to nullify the possibility of “democracy” so defined ever changing anything.

Where a capitalist mode of production operates, we invariably encounter “divided societies” – the title of a 1989 Miliband book emphasizing, against fashionable dismissal of its significance, the continuing centrality of class struggle – and it is an axiomatic outcome of the workings of the system, contrary to the mystifications put about by Tories depicting capitalism as a wondrous land of opportunity (“a very Eden of the innate rights of man” as Karl Marx sarcastically put it), that “hardworking people” are ill rewarded for their efforts. Those who merely control and direct their labour, by contrast, and can appropriate surplus value – profit arising from that segment of the working day, disguised by the fiction of hourly pay rates, that goes uncompensated by wages – are able to enrich themselves enormously. The NHS, at any rate outside of the inroads made by “privatization of the unprivatizable” (the felicitous phrase of a regular guest at Pathways group meetings, Al) does not directly generate surplus value, which is a prime explanation for capitalist hostility to it. Sadly, it does reproduce in microcosm the hierarchies and pay differentials that normally accompany capitalism, with a marked divide in prestige and income between doctors, nurses and patronizingly designated “ancillary” staff. The fault has been exacerbated by the latter-day accretion of a parasitic layer of managers and administrators who are generously compensated for their expertise in the manipulation of the “human resources” tasked with the mundane responsibility of actually treating patients.

Under neoliberalism, still in the process of consolidating its supremacy in Miliband’s lifetime, we are in a nightmare world of wage repression, shredding of employment rights and super-exploitative workfare that is ratcheting the inequities of capitalism up to hideous levels. Wages have fallen by 9% relative to inflation since the 2010 election, and unemployment benefit recipients, to combat a scandalous “something for nothing” culture in which they deprive the Treasury of an exorbitant £56.80 a week, or £71.70 if they are lucky enough to be aged over twenty-five, are compelled to slave for their pittances in workplaces ranging from discount retailers – the “pound shops” where Britain’s poor scavenge for affordable necessities – to residential care homes. (Their employers harness the prodigious “something for nothing” of unpaid labour, together with government subsidies in indemnification of their slave-driving altruism.) The knock-on implications of this can only make a parlous situation worse for the bulk of NHS workers, who typically describe themselves as “run ragged” in an environment where consultants earn £160,000 a year and a malfunctioning hospital trust, Mid Staffordshire, is unembarrassed to hire a “finance director” who rakes in £1475 a day. Indeed, the Department of Health has said it will renege on a miniscule wage rise of 1% scheduled for April of next year, and is shamefully blackmailing NHS staff by arguing that opposition to the pay freeze will put patients’ lives in jeopardy.

The availability of NHS services and welfare payments – meagre in value though the latter are – has been an important factor in the “system of containment” of radical change that Ralph Miliband dissected in his 1982 book Capitalist Democracy in Britain. They are, in the medical metaphor of Miliband’s 1977 study Marxism and Politics, a “prophylactic” against the contagion of revolution. They are not by any means an endpoint of socialist evolution. In Miliband’s view, nevertheless, we are in no way entitled to adopt an ultraleftist stance and disparage them as hindrances to instilling insurrectionary consciousness in the working class. Although, in the words of a Miliband essay of 1966, “the Welfare State has been more generous to the comfortably-off than to the poorly-off” (an imbalance that has not subsequently been remedied), the alternative of their absence, in the pre-revolutionary short term at least, would result in misery and death for millions of pauperized Britons. It is the alternative being prepared for us by neoliberal politicians, who will place profit above human life through NHS privatization, and move from barring people under twenty-five from claiming benefits – a policy mooted at this week’s Conservative Party conference in Manchester – to abolishing benefits altogether. Should they succeed in turning back the clock to pre-welfare state barbarism, society, to borrow a line from an essay called ‘The New Revisionism in Britain’ written by Miliband in 1985, “will continue, generation after generation, as a conflict-ridden, growingly authoritarian and brutalized social system, poisoned by its inability to make humane and rational use of the immense resources capitalism has itself brought into being.” From a Milibandian vantage point, then, the immediate task is one of fighting for the preservation of the NHS, while not overlooking deformations in its makeup that would need to be tackled in what Miliband sketched as “an altogether different society… whose organising principles will be co-operation, fellowship, democracy and egalitarianism.”

It’s unfortunate that Ralph Miliband was not alive to chronicle the careers (and I choose that word judiciously) of Tony Blair and Gordon Brown. There is a mordant sarcasm to his skewering, in Parliamentary Socialism, of the sorry record of Labour governments from Ramsay MacDonald to Harold Wilson – he spared only the Attlee administration from censure, and then only for its domestic policies up to the point at which legislative paralysis took hold in 1948 – that, if applied to the “new” new revisionism of  those twin horsemen of imperialist and economic apocalypse, would have made for a masterpiece of blackly humorous denunciation. (For obvious reasons, he might have blenched at extending the story beyond 2010.) Essentially, however, Miliband was not temperamentally disposed to ad hominem attacks; as the title of his posthumously published Socialism for a Sceptical Age intimates, and as exemplified by his non-sectarian editorship of Socialist Register over the course of three decades, his preference was for dialogue over dogmatic assertion. He was always a measured proponent of a project of human liberation within practicable limits, which makes the tabloid invocation of the metaphysics of evil all the more risible. For the enlightenment of Daily Mail hirelings and subscribers – not that we would welcome such people visiting this site – who consider Ralph Miliband’s pronouncements the ne plus ultra of incendiary left-wing rhetoric, instead of the soberly empirical investigations into reality they truly were, here’s a Surrealist slogan from 1925, authored by anarcho-Trotskyist provocateur Andre Breton, that is worthy of revival in what has become a lamentably unsceptical age of mass incarceration and imperial bellicosity: “Open the prisons! Disband the army!” To which we might wish to add as an equally pressing exhortation, “Burn the Square Mile!”

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.

Belated Thoughts on Thatcherism

Thatcher's gleeful butchery of the UK's postwar settlement

A ‘Spitting Image’ puppet of Margaret Thatcher, in a sketch that brings to mind Jonathan Coe’s satire on Thatcherite greed and corruption, ‘What a Carve Up!’


Men should drive towards the future over a thousand bridges and gangways, and there should be more war and more inequality among them!

Friedrich Nietzsche


Margaret Thatcher died, aged eighty-seven, on 8 April 2013. At her lavish funeral service nine days later in St Paul’s Cathedral, a ceremony which had about it no hint of the small state supposedly prized by Thatcherites, there was a reading from T.S. Eliot’s Little Gidding. Given the devastation that resulted from eleven years of Thatcher’s premiership, The Waste Land would have been a more apposite choice, even if her death disproves Eliot’s contention that April is the cruellest month; or perhaps The Hollow Men would have been fitting, in remembrance of the victims of deindustrialization and those whose livelihoods were sacrificed to the monetarist goal of curbing inflation (which stood at 9.7% when Thatcher exited Downing Street in November 1990, o.6% lower than when she entered it in May 1979). Obituaries of the UK’s first female – but scarcely feminist – prime minister have not been in short supply, and one ponders the necessity of adding to them. Nevertheless, as Thatcher’s legacy has blighted the lives of all members of the Pathways group (including that of the present author, Mark Conlon), a few words seem in order. Sean, a participant in our group for about three years, tells us that one of his ex-employers, in the pre-minimum wage era eulogized by Tories, paid him the munificent sum of £3 an hour, and published in his company’s newsletter a sycophantic poem praising Thatcher for overseeing the economy that permitted him to do so. Sean commends Elvis Costello’s ‘Tramp the Dirt Down’ as expressive of his feelings toward the politician Costello’s song paints as shaping a future “as bright and as clear as the black tarmacadam.” It is a sentiment I share, and one I will try to articulate in the course of this article.

David Sweetsur, in his blog, has written insightfully about Thatcher’s unwholesome Wille zur Macht, echoing Angela Carter’s 1983 description of the prime minister’s “steel-blue eyes glittering like bayonets… always with a glazed expression as if fixed on the vision of some high Tory apotheosis, such as the crucifixion of Arthur Scargill.” I will not supplement his observations by dwelling on the unattractive features of the woman’s personality. Putting such epiphenomenal matters to one side, the essential thrust of Thatcherite neoliberalism is plain: to ride to the aid of capitalism through measures designed to counteract the reemergence, after the “Golden Age” of capitalistic boom, of the long-term tendency of the rate of profit to fall. The objective was achieved, in so far as it has been achieved, through a savage attack on wages and organized labour (assisted, as Thatcher’s chief economic advisor Alan Budd candidly admitted, by the purposeful creation of a huge reserve army of labour, and in which the militarized struggle against the National Union of Mineworkers in 1984-5 was a watershed), and latterly by a colonization of the whole of life by the profit-seeking imperative, via privatization of state utilities, education and the National Health Service. Pari passu, the swindlers of finance capital were granted free rein to leech speculative profits at the expense of productive capital, with the melancholy results that ensued in 2007-8 (though latter-day Thatcherites, unwilling to see a good crisis go begging, have seized opportunistically on the debacle – in an example of Naomi Klein’s “disaster capitalism” and David Harvey’s “accumulation by dispossession” – as a pretext for the dissolution of the welfare state and parts of the public sector). The plummeting living standards of the working class, meanwhile, were temporarily disguised by a colossal expansion of credit, and through the cynical promotion of mortgage debt peonage in the context of a housing bubble that conferred on the vaunted “homeowner” an illusory sense of affluence, developments which in turn led to windfall profits accruing to financial vampirism. At the opposite pole, Croesus-like wealth was concentrated in the hands of a tiny plutocracy, the 1% targeted since 2011 by the activism of the Occupy movement. The laissez-faire counterrevolution was topped off with a revival of imperial aggression and military expenditure, with Iron Britannia (as Anthony Barnett memorably dubbed the newly belligerent state) waging an adventurist war in the South Atlantic – thereby paving the way for Tony Blair’s bloodier imperialist crimes – and partnering Ronald Reagan’s USA in escalating the Cold War.

These broad outlines are hardly difficult to discern, but one would have learned nothing about them from Margaret: Death of a Revolutionary, Martin Durkin’s absurd hagiography of Thatcher shown on Channel 4 shortly after her passing. At the Pathways group meeting on 16 April, David Sweetsur remarked on the fantastical nature of the programme, which seemed entirely divorced from the bleak realities of the UK in which he and I grew up. In a dissertation lasting over an hour, no reference was made to such inconvenient facts as engineered mass unemployment, the squandering of North Sea oil revenues on tax cuts for the rich, the switch to reliance on regressive forms of taxation like VAT, burgeoning homelessness and child poverty, the riots engendered by racist neglect of the inner cities, the frightful consequences of the casino economy unleashed by the deregulation of banks and the City of London in 1986, the use of murderous “shoot to kill” tactics against Irish republicans, or the revealing contrast between Thatcher’s lauding of Augusto Pinochet and her condemnation of the “terrorism” of African National Congress activists. Instead, viewers were told that Thatcher had swept away Britain’s class system and emancipated British workers by removing the shackles of trade union membership. In support of these outlandish claims, working class shoppers in Basildon were given a few seconds to trumpet Thatcher’s virtues (“I think she was really good” being a typical contribution), before further elaboration of them was assigned to such doughty fighters for the proletarian cause as gutter journalist Kelvin MacKenzie and Adam Smith Institute ideologue Madsen Pirie. They discoursed ad nauseam on the lush pastures of freedom to which the Thatcherite dispensation had transported us – and not merely us, since apparently Soviet Communism disintegrated under the basilisk glare of the Iron Lady – or rather on the enhanced freedom in the 1980s to make money and acquire property, which are the only liberties that matter to apologists for a recrudescent solipsism of gaining wealth, forgetting all but self. Durkin’s idea of presenting an opposing viewpoint was to wheel on Neil Kinnock, a revisionist of revisionism who would have had Eduard Bernstein spluttering with indignation, to deliver snippets of his incoherent windbaggery. Such is the honesty and intellectual calibre of Thatcher’s cheerleaders. The truth is, contra Durkin’s preposterous thesis, that if Thatcher was revolutionary, it was in the manner of Sergei Nechaev, raining down “pitiless destruction” on the working class.

One would have turned in vain to the BBC for a more critical perspective. Television coverage of Thatcher’s funeral did its utmost to banish the memory of Dennis Thatcher’s jibe that it might better be named the Bolshevik Broadcasting Corporation (always a ludicrous allegation, levelled as it was against an organization that tampered with footage of striking miners to convey the false impression that they, and not the police arrayed against them, were violent thugs). Peddling its usual line of national unity as a balm to soothe class division, we were informed, in the magniloquent tones of the BBC presenter determined to impress on an audience the gravitas of establishment tradition, that the service would “reflect her lifetime dedication to the country.” The Corporation even managed to unearth a Liverpudlian supporter of the ex-premier, omitting to mention that, in Liverpool itself, the city council dared not publicly broadcast the event for fear of provoking an angry response. Not that any of this dissuaded Thatcher’s besotted biographer Charles Moore from accusing BBC presentation of falling below the requisite degree of reverence. At St Paul’s, workfare advocate Newt Gingrich, convicted fraudster Gerald Ronson and recidivous war criminal Henry Kissinger, among other miscreants too numerous to list, filled the pews in recognition of Thatcher’s pursuit of high moral principle. Chancellor of the Exchequer George Osborne was moved to tears by the sadness of the occasion, a marked divergence from his buoyant mood when announcing the latest round of austerity cutbacks. In the end, for all its martial bluster, the funeral turned out to be a pompous bore: with the police having power to make preemptive arrests, and more than 4000 officers deployed on the day, disappointment lay in store for those hoping that a denouement in the spirit of Lindsay Anderson’s If…. might bring the turgid proceedings to an abrupt halt.

In a 1981 interview with Ronald Butt for the Sunday Times, Thatcher said of her policies: “Economics are the method; the object is to change the heart and soul.” As the unreconstructed hearts of our group demonstrate, she failed in this terrifying ambition. There are no subscribers in our ranks to David Cameron’s triumphalist rhetoric about us all being Thatcherites now, still less to sociologist Stuart Hall’s overblown assessment of Thatcher as some kind of Hegelian “world-historical” figure. (A leading spokesman of the capitalist class, Richard Nixon, once declared us to be Keynesians, in more progressive times when that class could not have bragged of its dominance in the aggrandizing fashion of a Cameron or a Warren Buffett.) With the Conservatives under Thatcher never surpassing the 43.9% share of the vote they gained in the 1979 general election, defeatists like Hall and his erstwhile colleagues at Marxism Today were always guilty of exaggerating the rightward shift of the electorate; but inasmuch as the shift occurred – what one might term a manifestation of vox populi, vox diaboli it was one to which Pathways group members remained resolutely immune. Dom has been fortunate in shedding most of his memories of the Thatcherite nightmare, but does remember his mystification at the fervid warmongering of 1982, stirred up over an obscure colonial archipelago the precise geographical location of which he was unaware (an ignorance he had in common with a majority of the UK’s population prior to Leopoldo Galtieri’s invasion of the Falkland Islands/Malvinas). Sara Cooper recalls the manifest injustice of the Poll Tax, and is relieved that Thatcher’s offspring did not attempt to found a right-wing dynasty by standing for political office. Mercifully, they had other things to distract them: while Carol Thatcher partook in the cultural baseness of the neoliberal age by appearing on celebrity TV programmes, Mark Thatcher, imbued with the rectitude imparted by a petit-bourgeois mother and haute-bourgeois father, preferred to devote his energies to Saudi Arabian arms dealing, South African loansharking, and the fomenting of a coup in Equatorial Guinea.

Karl Marx suggested that, in pressing on towards the future, one ought to “let the dead bury their dead.” Let us accordingly have done with an elderly woman’s overdue demise, and leave it to those who extol the dead labour of capital to mourn the departure of their ideological heroine. The urgent task now is to inter a capitalist system in severe structural crisis, made more barbarous in recent decades by its recourse to the extremist nostrums of Friedrich Hayek and Milton Friedman, for whose abhorrent creed Margaret Thatcher was an evangelist. A final thought, however: should the proposed memorial to Thatcher see the light of day, one hopes that, in time, it will be destined for the fate which Gustave Courbet and the Paris Communards deemed appropriate to mete out in 1871 to the Vendome Column.