Aiming at the Causes of Anxiety (and a lot of mental suffering)
Recently, I found a great article that outlines how our current socioeconomic-political structures contribute to the causation of anxiety and other mental and physical health issues. Please consider this excerpt:
“Clinical psychologist and psychotherapist Jay Watts observes in the Guardian that ‘psychological and social factors are at least as significant and, for many, the main cause of suffering. Poverty, relative inequality, being subject to racism, sexism, displacement and a competitive culture all increase the likelihood of mental suffering. Governments and pharmaceutical companies are not as interested in these results, throwing funding at studies looking at genetics and physical biomarkers as opposed to the environmental causes of distress. Similarly, there is little political will to combine increasing mental distress with structural inequalities, though the association is robust and many professionals think this would be the best way to tackle the current mental health epidemic’.”
The irony in all of this is that the vast majority of mental issues are created by our social systems and their interaction with human biology. We’re then naive enough to ask the same system to fix the problem. That is: the capitalist system in which we must abide nowadays sells us a solution to the problems it causes.
There are various reasons to argue this. For one, there is no money or incentive to tell people who are suffering from anxiety to go exercise or to reconsider the relationships in their lives. Furthermore, no psychiatrist or therapist can singlehandedly change our collective social systems, so even ‘going there’ is generally off of the table. Indeed, it would be very unlikely to hear a mental health counsellor educate someone about how the market economy relates to human biology or nature. Since therapists are in the business of therapy, they require a constant intake of clients to pay their bills. Professional therapy is for profit. Indeed, this is not hidden. Since 1980 (when they changed the diagnostic focus to symptoms and not causes), the answer emanating from psychiatry has been diagnoses and drugs. In clinical psychology it has been testing and talk-based therapy. In either case the advertising claims that there are effective solutions for sale that are signed off on in the name of science and medicine. They’ve effectively created a kind of credentialized hegemony (power structure) where only they can know what the problem is and how to solve it.
The problem though, is that drugs and talk therapy addresses symptoms, and not causes. For instance, the cause of anxiety is not a lack of a drug or a lack of a talk therapist. Instead, the cause of anxiety can be found in someone’s very specific living circumstances. But this seems to be lost on a lot of physicians nowadays. They tend to just believe that human biology exists in a vacuum where any problem must be related to some kind of internal malfunction. Amazingly, I just had a conversation with a physician where the discussion went as follows:
Me: Don’t you think that diagnosis and treatment in psychiatry is unscientific, that it is diagnosing people without evidence and thus providing potentially dangerous drugs to people without any evidence?
Physician: Sure, but I don’t see the problem with giving someone a pill to make them feel better. And we know they work, even if we don’t understand the cause. We know this because people take them and then come back and say they feel better. That’s evidence enough for me.
Me: But you never perform biological tests on someone you sent away with your drugs. How can you know it’s the drug that’s working and not something else?
Physician: We don’t know, but who cares if the problem seems solved?
This was an actual conversation. Indeed, there is a lot of philosophical consideration missing from this physician’s position.
The problem with pills or talk therapy for anxiety is that if the circumstances in one’s life do not change (capitalist society won’t change quickly) then people might end up in therapy or taking medications indefinitely. This, admittedly, is a pharmaceutical company’s dream. To have people pay a monthly rent to ‘treat’ anxiety provides guaranteed profits. To have a society bent on inflicting non-stop stress on people is and failing to address it is also beneficial for the therapy industry. The two shake hands.
The narrative that is generally used to hide the facts about the social causes of anxiety to sell the drugs are found in psychiatric language and diagnosis, where they claim that various anxiety disorders are brain-borne discrete ‘genetic’ problems that people inherit from their parents. Yet, literally everyone has anxiety and it is getting to the point where the majority of persons could be said to qualify for a diagnosis of ‘anxiety disorder’ in their lifetime. The truth is: anxiety is a very human reaction to circumstances. It is a self-protection mechanism designed to ensure a person’s survival. So it doesn’t follow to argue that anxiety is ‘genetic’ as a way to pathologize it: it is genetic and normal. This kind of medicalized talk makes people believe that there might be some actual biological dysfunction in their brains that requires ‘balancing’.
Indeed, the ‘chemical imbalance’ tale has been told ad nauseum to sell psychiatric drugs. These kinds of narratives offer an oversimplified solution to what people consider to be their problem, and not a problem inflicted upon them.
The reason people tend to look inward (it’s my brain that’s broken) and not outward (it’s society and my circumstances therein) is because this has also been taught to us by, you guessed it: the system we live in. If you lose your job and can’t pay your bills, it’s your problem – work harder! If you lost your home because the company you work has downsized to make more profits for someone else, then: it’s your problem. So it isn’t surprising that when your biology starts to push back in the form of stress, anger, anxiety, depression (etc) that we blame our biology.
There is a counterexample, though. When someone is so down and out because of things that have gone on in their life that a medical intervention is needed to get them back to even keel, reducing symptoms for a time might be defensible. Problematically, this isn’t what is being offered by our first line therapists, though. There is generally no mention of short term symptom reduction in efforts to learn about why the problem happened in the first case to then sort out long term solutions. Ideally, this would be the case: that anyone who went to get therapy for mental distress would be offered long term solutions that looked upon every facet of their lives.
The reason this is not offered is because the health systems we’ve created do not have the capacity or time to deal with complex mental health issues. It would simply be too expensive to have people in therapy for years or to even consider social circumstances. Therefore, fixing social problems or even acknowledging the socioeconomic and political systems we have in place are causing and aggravating the issue are silenced.
In our current health ‘system’ the aim is to get people back to ‘functioning’ as quickly as possible so they can go back to work and get on with their lives. Please make special note of the fact that therapy is generally given in efforts to have people “function” again. They don’t say “be happy”,”thrive”, “establish a sense of contentment”, or “calm” – they say “function”. I think the reason they say this is because ‘dysfunction’ in our society is frowned upon. But what does it mean to function? Is it really just calculated on whether or not you can go to work and make money? The belief underlying this is that we should all be fit to work and produce and any failure to do so is simply ‘dysfunctional’.
Also note, ‘function’ and ‘dysfunction’ are applied to the individual and not the society or context in which that individual is living. This lopsided consideration one of convenience and not truth – it is easier and less expensive to blame an individual or their biology than it is to change complex and deeply ideologically ingrained social systems. Indeed, I could easily argue that a health system that provides only symptom relief through the use of medications with no long term strategy or even analysis of social factors is ‘dysfunctional’ in-and-of itself. It could also be argued as socially dysfunctional that in Canada provincial governments generally only insure psychiatric services (despite a list of other kinds of therapy) is a direct indication as to who owns the politicians and power in our current mental health system.
Thankfully, not all therapists behave or believe in this way. Many believe that bigger picture thinking and aiming at causes is the way to help someone move forward. The problem though is that when government, psychiatry, and big pharma team up, they market their position so well that the general public come to offer them a prima facie credibility without ever putting it into question. “It’s the government and doctors, of course it must be right and true,” is the tendency. Moreover, these groups have bottomless pits of money they can aim at advertising their beliefs, products, and time. They have government grants to study and publish research, pharma money to promote and distribute, and overall they own the market. No one questions the research or the advertising – they just accept it as they may be too busy trying to ‘function’ to ever be able to question what is actually going on.
Under capitalism everyone needs to get paid. It is ingrained in everything we do. People will do anything to make money and will ‘innovate’ to solve problems. They’ll then expect compensation for having solved the problems. Right now, anxiety is a problem that has been created by society that is also being ‘treated’ according to the ideologies inherent to this same society. This has to change. For people to learn to live peacefully and not be inflicted with chronic stress and anxiety (and other manifestations of mental distress), then it will require an inventory, analysis, and hard look at how we ought to change social systems to accommodate human biology, and not the other way around.