By HC116, April 22, 2005
"Being totally happy under imperialism is unlikely if you care about oppression."(1)
One of the shared tactics of psychiatrists and therapists--from card-carrying licensed psychotherapists to Scientology auditors--is to oppose, mostly in words only, the stigmatization of persyns with so-called mental health problems, but encourage people to tease out their feelings of helplessness and vulnerability and identify themselves as ill, abnormal or at least aberrant. Last night's Larry King Live was an example of this practice. Oh-so-concerned Larry King gathered together celebrities and "experts" who talked about their experience with depression. They encouraged viewers to seek treatment for their own depression and mentioned no alternative to the failed individualistic, supposedly apolitical therapy and drugs approach. There were some, limited remarks about "environment and life stresses," but the context of this was interaction with genes.(2) The language of "environment," rather than "society," was even too hesitant. Dr. Karen Swartz, from the Johns Hopkins School of Medicine, said: "There's strong evidence -- for many people -- that there's a strong genetic component. We know that this will run in families, but it's more complicated than that, because, even with identical twins with bipolar disorder, if one identical twin has the illness, only about 50 percent of the time will the other twin have it."(1)
The Larry King Live guests did not touch on how depression manifests differently in different countries and societies. On the contrary, Dr. Karen Swartz exaggerated the similarity of depression incidence rates world-wide, saying that depression is "not something that is dramatically higher in the United States compared to other countries." In fact, an estimated age-standardized unipolar depressive disorders incidence rate for females in the united $tates and Kanada combined is 7160/100,000/year, whereas the estimated incidence rate for females in Australia, Japan, and New Zealand, combined is much less: 2762/100,000/year.(3) In addition, Swartz rejected social explanations for "depression" outright:
"You could argue -- you could argue that our lifestyle may contribute and that there's a lot of stress or expectation, but I think that the issue is that it's a very common illness, the same way that high blood pressure is a common illness, or diabetes is a common illness. And so, when I think you have something common, it's easy to turn to our society and say that's the answer. I think biology is going to be more of the answer."
Swartz viewed depression as mainly a biological problem, suggesting that depression rarely has any "precipitating factor" worthy of attention. Even if depression were mainly a biological problem--in which case the psychiatrists must prove that depression will appear regardless of the type of society (not just geographic location)--the proletariat's approach to medicine, putting politics in command and serving the people, differs from the oppressors' methods. However, MCB52 points out in MIM Theory no. 9: "a biochemical component is not the same as a biochemical basis, and either is less dangerous in theory than genetic theories, which are widespread among Amerikans. China developed simple ways of dealing with such [schizophrenic] patients, for example, exploring which dietary plans reduce the symptoms of nausea and prolonged comas. The manifestations of schizophrenia are social even if there is a chemical component or basis." (p. 37)
Something that needs pointing out is that comparisons made between mental illnesses and broken arms for example, in order to justify psychiatry and therapy as an institution, are wrong, except in a tiny percentage of obvious cases as uncommon as growing a third arm. The imperialist-patriarchy breaks bones all the time, but the solution to that is not for all revolutionaries to become doctors, much less doctors in imperialist-dominated clinics and hospitals; although, the exploited and oppressed always need revolutionary doctors. MIM says to wage revolution. The vast majority of psychologists and psychiatrists don't even envision a society without group oppression, and that needs to be called out. It inevitably shapes their whole outlook in regard to so-called mental illnesses. Consequently, psychiatry patients and therapy clients don't even consider that their so-called mental illnesses might be ideological or social in nature. Even when the "environment" or their "relationships" are considered, the problem is isolated to the individual's immediate local context, and the goal is to bring the persyn into harmony with the oppressive and inherently dysfunctional status quo.
Mental health professionals' so-called anti-stigma props up the reactionary mental health care system and therapy culture and is devastating to the oppressed. MIM condemns the whole therapy culture--a lifestyle and comfort for the oppressors, but a tool of the oppressors against the oppressed. The exploited and oppressed need and demand better than that and can look to revolutionary China for historical experience relating to mental health.
MIM discusses psychological practice in revolutionary China in MIM Theory no. 9 . Martha Livingston and Paul Lowinger's The Minds of the Chinese People: Mental Health in New China (Englewood Cliffs, NJ: Prentice-Hall, 1983) is an important book. It is interesting to see what another certain source has to say. Amerikan psychiatrist Seymour S. Kety observed in China in 1974 first-hand:
"On 17 June 1974 we visited a commune outside Canton with a population of 68,000 where we had an opportunity to confer with the medical staff. In the course of our discussion I had an opportunity to inquire about schizophrenia which, it was said, was rarely seen and, when it occurred, was referred to the mental hospital. The medical staff knew of only one or two psychotic breaks a year and did not recall any suicides. This of course is in marked contrast to the situation in the United States or in most western countries where several hundred psychiatric care episodes would be expected annually in a population of that size" (pp. 315-316).(4)
Although doctors supposedly used drugs with some mental health patients, "[n]ow doctors, nurses and patients live and work together, exchanging ideas. The patients are no longer confined but are free to go into the community where they may do manual labour or other kinds of useful work." (p. 317)(4)
In Dr. Wu Chen-yi's clinic, Kety observed:
"There was no evidence of bizarre behaviour in any of the patients although there were a few emotionless faces and some patients who did not sing in the general choruses. Few of the patients seemed older than 45 years and I saw no senile patients. Dr Wu indicated that the bulk of the patients was representative of the major psychoses, mainly schizophrenia and the affective psychosis. Judging from the appearance and attitude of the patients the response to therapy was most impressive and comparable to what one would see in the better psychiatric hospitals in the United States. . . . Since Liberation, relationships between people have improved so that the family or companions can help in taking care of such patients making it unnecessary to send them to a chronic hospital" (p. 318).(4)
Also, Kety suggests that people in revolutionary China were more accepting of "mentally ill" persyns, and that the acceptance would explain the much less frequent hospitalization of people for so-called mental illnesses. Kety notes that despite the use of some psychiatric techniques, including drugs in some circumstances, psychiatry was in an overall decline.
Revolutionaries oppose the classification of the oppressed as mentally ill, oppose the stigmatization of "mentally ill" persyns, treat patients as comrades, and consciously subordinate psychological practice--in decline after the seizure of power--to the revolutionary struggle. The National Institute of Mental Health, the National "Alliance for the Mentally Ill," p$ychopharmaceutical capitalists, and others, pathologize the behavior of the class-, nation- and gender-oppressed, and pretend to oppose the stigmatization of mentally ill persyns for the sake of expanding the reaches of psychology. Whether it is Mike Wallace's saying "I owe it to let people out there understand, Larry, it can be treated, you can get better, and it is not all that difficult if you hang in there," or endless disarming television commercials calling on the viewer to admit their mental illness and submit to treatment, the effect is to consolidate psychology further and universalize the psychological surveillance and control of oppressed nationalities, homeless persyns, and people who are oppressed under patriarchy.
Depression and suicide
Although suicides rates, including youth suicides rates, have been declining, the question arises is it useful to "oppose" stigma in the way psychologists do, to encourage suicidal wimmin or youth for instance to seek help in the form of mental health treatment. The answer is no. Only revolution can end youth suicide in the long run. It is better to dedicate 10 hours to working with MIM than working with NAMI. And the oppressed need their own independent institutions for mental health to the extent there are mental health problems. The mentality of settling for the oppressors' mental so-called health care is self-defeating.
A related question is whether people should postpone getting "support" until they meet a revolutionary. The answer to that question is also "no," but with the qualification that the persyn should make their struggle with suicide political, and avoid or at least be conscious of the individual treatment trap. Suicide is an enemy to be defeated. "I have the ability to contribute however little to abolishing that society and releasing others from similar (and greater) oppression. I shouldn't shrink before this opportunity, but rather should put every possible effort into seizing it. Mao, in discussing suicides of women in pre-Liberation China, did not blame them for taking that action but did call them to revolutionary action."(5)
1. MCB52, "Psychological Practice in the Chinese Revolution," MIM Theory, no. 9 (1995): 37.
2. "Panel Discusses Treatments for Depression," http://transcripts.cnn.com/TRANSCRIPTS/0504/21/lkl.01.html
3. T. B. Ustun, J. L. Ayuso-Mateos, S. Chatterji, C. Mathers, and C. J. L. Murray, "Global burden of depressive disorders in the year 2000," British Journal of Psychiatry , 184 (2004): 386-392.
4. Seymour S. Kety, "Psychiatric Concepts and Treatment in China," China Quarterly , no. 66 (1976): 315-323.
5. "Disavowing suicide : Testimonial of a Woman Revolutionary," MIM Theory , no. 9 (1995): 45.