Mental Health, Dual Power, and the State

by Natasha Stoudt

Amidst the storm of media coverage on the recent mass shootings have been many calls for changes to the American mental health care system. While I have found a rare point of agreement with President Obama that we need a “national dialogue on mental health,” much of the content of this dialogue has been deeply troubling. Many have advocated for greater leeway on the part of mental health professionals to institutionalize those they deem a potential harm to others, as well as for greater state monitoring and restriction of those diagnosed with mental illnesses. Were these policies enacted, not only would they likely have little effect on stemming the violent expressions of poor mental health, the repercussions on targeted individuals could be dire. The answer to addressing our nation’s mental health crisis – and it is certainly that – lies not in tighter state control but in community structures that support healthy mental and emotional functioning throughout the lifespan.

Advocates of giving mental health professionals increased latitude to institutionalize people forget that the current set of circumstances under which a person can be legally committed—that they present risk of imminent danger to themselves or others—are the legacy of the work of activists who fought to change a system in which people were regularly institutionalized on the basis of such characteristics as not conforming to one’s assigned gender, being disruptive in school, or having some delusional beliefs. In the 1970s, the US Supreme Court established the guideline of imminent danger in response to these abuses, which theretofore had left hundreds of thousands of nonviolent people languishing in mental health institutions indefinitely. Subsequently, the paradigm shifted towards a more community-based model with an emphasis on outpatient care. Although abuses are unfortunately still common under the current model, they are far less so today than fifty years ago, and expanding the abilities of mental health practitioners to institutionalize patients would be a step backwards towards an era of rampant psychiatric abuse. Additionally, increasing state control of those with mental health diagnoses would likely discourage people from seeking help. The valid fear of unnecessary institutionalization and related psychiatric abuses combined with our culture’s stigma towards receiving psychological help already constitute a barrier between individuals and mental health care; adding to this barrier would prevent mental health care from reaching many of those who need it most, including those who may become violent.

If one chooses to lobby the state for structural changes to the mental health care system, a far better tack would be to advocate for single-payer health care, state-subsidized higher education, and increased funding for social programs like Head Start. Under a single-payer system, not only would those without mental health insurance coverage be able to receive care, those who do currently have insurance would be able to access services without the endless shuffle between providers due to coverage changes and fights with insurance companies to continue receiving therapy. Subsidized higher education would allow a larger, more diverse group of people to enter the mental health care professions, redistributing some of the strain from overburdened community mental health practitioners whose unreasonable caseload undermines the effectiveness of their work, and bringing therapeutic interventions to a wider range of people. Finally, funding programs that foster healthy early childhood development would address the prevalence of mental health issues on a preventive level. Given their likely effectiveness, why do we see so little advocacy of these particular changes in our “national dialogue” on mental health care? There are likely a few reasons, such as these policies seeming implausible due to government corruption and bureaucratic gridlock, or that they would take too long to create noticeable effects. However, there is a more insidious reason underlying the advocacy of state control of people with mental health diagnoses: our society’s adoption of a reductive medical-biological model of mental illness.

The medical-biological model of mental illness is the idea that mental health difficulties are organic medical illnesses akin to physical disease. The concept of mental illness as “a matter of brain chemistry” and psychiatric drugs being similar to “insulin for diabetes” has reached a level of social saturation as to become cliche. The cultural narrative around so-called mental illness is a kind of pseudo-scientific storytelling in which we accept biological explanations with little evidentiary support – for example, no study has ever shown anything approaching a consistent correlation between low serotonin levels and depression, but the average American could probably repeat the idea that diminished serotonin is the “cause” of depression. While it would be foolish to claim that biological predisposition plays no role in the development of mental illness – some more than others – the medical-biological model obscures the reality of the relational, societal, and other environmental factors that affect brain functioning and cause mental health to deteriorate. It locates the origin of mental health difficulties within the individual, rather than in the interplay between the individual and their environment. When mental illness is conceived of as a problem of individuals, the emphasis shifts towards managing the problem through domination and control, rather than solving the problem by restructuring our social environments to support mental health. Pharmaceutical companies capitalize on the medical-biological model by subsidizing poorly designed, biased research to support it; forming unethically intimate relationships with powerful psychiatrists who then disseminate inaccurate information along with their drugs; and of course, by peddling marginally effective medications to those who are desperate for relief from their suffering. Insurance companies also benefit because it enables them to pay for relatively inexpensive pharmaceuticals and/or short-term therapies rather than the longer term psychotherapy that many people need in order to recover from their emotional difficulties. Ultimately, the medical-biological model serves the entirety of capitalist society because it conceals the role of capitalist social structures in damaging our collective and individual emotional health.

As anarchists and radicals, we know if we sit back and wait for the state to fulfill our needs, we will be waiting for the rest of our lives. In addition to demanding change and advocating for the rights of those with mental health diagnoses, we must create dual power structures to support emotional health within our communities. One starting point is to center the health of ourselves and our comrades as we build our organizations and movements. In our zeal to effect change, radical communities often expect an unsustainably high degree of time commitment and activity, leading to emotional and physical burnout, and shaming, both implicit and explicit, of those who are unable to keep up. We need to investigate how to better support each other through our individual and collective struggles, to resist the tendency, programmed into us by a capitalist society, to remain isolated, to keep our relationships on a superficial level, and to run ourselves ragged with work. Study after study has confirmed what we all know intuitively: that community and strong social relationships have a protective effect on emotional health, even and especially for those most at risk. To protect those relationships, we must prioritize improving our skills at conflict resolution and compassionate communication. We also need to educate ourselves about how to recognize and best support those going through a mental health crisis, without minimizing or stigmatizing. We need to enthusiastically and creatively establish collective care models and celebrate each other’s self-care. And we need to actively undermine the cultural stigma that prevents people from seeking psychological help.

The healthier and stronger we are, as individuals and as collectives, the more empowered we will be to take action and change our world in the myriad ways that we envision. And the more we experiment and find effective ways to support each other’s healing and wholeness, the more we will be able to demonstrate to our larger communities that another world is possible: a world in which no one need rely on state control to carry the weight of our collective mental and emotional difficulties, because we have rebuilt our ability to shoulder that responsibility ourselves.




  1. Pingback: Monday News Round-up: March 25, 2013 | The Portland Radicle - March 25, 2013

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