Powerless and Naked - Our Collective, Political Mental Health
Why has therapy been made so expensive?
Most discussions of mental health pigeonhole mental health issues as individual events, emanating from personal problems such as loneliness and job dissatisfaction. Society’s broader role as part of the capitalist system in causing such difficulties remains unacknowledged or ignored.
Our critique believes in over-determinism: that the political, economic, cultural and natural aspects of society affect and in turn are affected by each other. This departs from the narrow dichotomy of cause and effect, because no one part is gifted an existence prior to or independent of the other parts.
“Mental” health and its associated illnesses are often considered secondary to “physical” health. They are supposed to be restricted to people who can afford to maintain a decent level of bodily well-being.
The most commonly known source of help to address mental illnesses is therapy, but therapy has been made expensive, limiting it to only a few blessed people.
It is wrong on our part to exclude the majority of Indians, who are now at the brink of survival, from discussions on mental health provision. What we call the capitalistic structure ravages society, and affects the dispossessed more harshly than the owners.
According to the National Crime Records Bureau report in 2017, over a fifth of the total recorded deaths by suicide were of daily-wage earners – 22 percent – as against 9 percent for professionals or salaried persons. (That year’s Periodic Labour Force Survey estimated that one-third of working Indians earn a daily wage.)
The COVID crisis and ensuing lockdown can only have made things worse. Events are being unfolded by a system built upon these classes of people it has rendered powerless and naked. They are being left to traumatic mental stresses in harsh living conditions.
One of the many glaring forms of exploitation by the existing system is child labour. The 2011 Census recorded 10.1 million children engaged in paid economic activities in India. Child labour is prevalent not only in glass and carpet industries but also in the production and supply “chains” of giant corporations.
Many studies have highlighted the hostile living and working conditions of these children. Being physically and mentally scarred from a young age increases the likelihood that these children will suffer aggravated mental distress as they become adults.
The workings of capitalism are also manifested through the systematic occurrence of debt traps, especially among farmers who often collapse under growing debt burdens and are driven to suicide.
For the most impoverished classes, any economic or environmental upheaval denies them the basic minima of biological subsistence. Disruptions which seem insignificant to us threaten their families’ lives. Their constant struggle for bodily survival should not lead us to trivialise the emotional tumults and mental distresses they experience almost on a regular basis.
In light of this dire situation, the provision of economic resources is often touted as a solution. But this approach has a paternalistic undertone: it perceives “the poor” as a class of people who long only for primal requirements: eat, sleep and reproduce. We thus narrow down all of their problems to the absence of money.
But dignity in the workplace and in society in general is a crucial denial which we don’t account for. Dignity comes to the fore when we observe the deep divisions in our society on the lines of caste, gender, religion, ethnicity, sexuality, etcetera. Discrimination along these hierarchies robs people of their dignity and adversely impacts the mental health of both oppressor and oppressed.
The grave repercussions of such vicious discrimination include the deaths of Rohith Vemula, Payal Tadvi, Fathima Latheef, of women or queers who were the victims of sexual assault or whose aspirations were choked by patriarchal, misogynistic norms.
Such systematic oppression, predominantly through humiliation, isolates people targeted on the basis of their identity, and eventually, in cases both regular and extreme, it aids and abets their suicide.
Even among the few classes of people with sufficient social, cultural, economic capital, mental health issues pose a major obstacle to their lives.
The middle and upper middle classes are increasingly plagued by major expenses for essentials like home and education loans or medical bills. Perhaps most of their mental health problems can be traced back to the incessant need to keep up with their busy aspirational lifestyle.
By imposing an unhealthy and unfair competition, the system entraps them. Their situation is akin to a hamster on a wheel. The hierarchical and unfairly competitive environment concocted by the capitalistic structure compels these people to focus solely on their individual selves. This severs any sort of community ties, causing them to fall in the abyss of loneliness.
This all-consuming individualism is daily created and nurtured to maintain an alienated workforce and a loyal consumer base. To keep this system running, there is constant pressure to be continuously productive – economically – and to keep consuming.
The system, by promoting acute competition for resources rendered scarce by the owners, acts like a pressure cooker which too often takes a toll on people’s mental state: Nearly 8 percent of all suicide victims in the country were students (NCRB 2017). Young engineering and medical students in Kota are dying by suicide almost every year as competitors in this rat race.
Much like gender discrimination, mental health issues are pervasive in all classes of society.
Discussions on mental health will be absurdly incomplete with this elephant in the room.
Suicides and mental health problems are not individualistic. They are the byproducts of oppression, discrimination, exclusion and alienation through competition, which are the essential cogs in the wheel of capitalism.
Satyaki Dasgupta and Annesha Mukherjee are research scholars at the Centre for Development Studies, JNU, Kerala