Wednesday, September 21, 2022

Personal Troubles and Public Issues

"People do not usually define the troubles they endure in terms of historical change and institutional contradiction." Developing a sociological imagination is necessary so that, "By such means the personal uneasiness of individuals is focused upon explicit troubles and the indifference of publics is transformed into involvement with public issues....To understand the changes of many personal milieux we are required to look beyond them."        ~ C. Wright Mills in "The Promise"

"It is no measure of health to be well adjusted to a profoundly sick society"        ~ attributed to Jiddu Krishnamurti in Mark Vonnegut's The Eden Express

There was an excellent op ed on mental health, by Danielle Carr, in the New York Times yesterday. I'm saving pieces here. She looks at how we treat mental illness, and how futile some efforts have been. Many have been led to believe the problem is a matter of access to care, but she goes down a different road.

Are we really in a mental health crisis? A crisis that affects mental health is not the same as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?

It's politics. She uses the term "reification" to explain the institutional gaslighting in which political problems are spun as personal problems which conveniently "abracadabras" away any nosy questions about who started it and who benefits from it. 

It's how, for example, the effects of unregulated tech oligopolies become 'social media addiction,' how climate catastrophe caused by corporate greed becomes a 'heat wave'--and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become 'inflation.'

In medicine, it's called "medicalization," which focuses on an individual's body while ignoring the social system that's often at the root of the problem. Like with the mental health issues arising from Covid. Incidents of depression and anxiety have increased dramatically, but that's not surprising given the circumstances: "feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health." Looking at the data, economic security is the biggest predictor of a mental illness during a crisis: "it's not simply a question of the numbers on your bank statement - although that is a major predictor of outcomes - but of whether you live in a society where the social fabric has been destroyed."

She uses an analogy of someone running people over with a car. We don't call it "Got Run Over by a Car Syndrome," but actively try to stop the driver who's running people over. With Covid, we're looking with sympathy at the people struggling with mental health, but then doing next to nothing to stop what's driving it. 

There is increasingly strong evidence for the idea that chronic elevation of stress hormones has downstream effects on the neural architecture of the brain's cognitive and emotional circuits. . . . When it comes to mental health, the best treatment for the biological conditions underlying many symptoms might be ensuring that more people can live less stressful lives. And here is the core of the problem: Medicalizing mental health doesn't work very well if your goal is to address the underlying cause of population-level increases in mental and emotional distress. It does, however, work really well of you're trying to come up with a solution that everybody in power can agree on, so that the people in power can show they're doing something about the problem. Unfortunately, the solution that everyone can agree on is not going to work. 

She looks at what it would take to reduce the social causes of diabetes, as an example, to show that once we stop looking at it as biologically driven, the other issues are overwhelming, including everything from transportation infrastructure to corporate lobbying, and too many people benefit from our current system. Looking at Biden's mental health plan, that motions to social ills without actually addressing them, 

When the plan addresses suicide, it focuses on crisis intervention--as if suicide were a kind of unfortunate natural occurrence, like lightning strikes, rather than an expression of the fact that growing numbers of people are becoming convinced that the current state of affairs gives them no reason to hope for a life they'd want to live. . . . It's not so much that the hotline is a bad idea; it's that the sheer scale of failure to comprehend the political reality that it displays, the utter inability to register how profoundly the 'suicide epidemic' indicts the status quo, is ultimately more terrifying than outright indifferences. 

Solving the mental health crisis, then, will require fighting for people to have secure access to infrastructure that buffers them from chronic stress: housing, food security, education, child care, job security, the right to organize for more humane workplaces and substantive action on the imminent climate apocalypse. 

A fight for mental health waged only on the terms of access to psychiatric care does not only risk bolstering justifications for profiteering invoked by start-ups eager to capitalize on the widespread effects of grief, anxiety and despair. It also risks pathologizing the very emotions we are going to need to harness for their political power if we are going to win solutions.


BUT, people in power have spun things in their favour for millennia, while people were starving and fighting each other, and trying to topple the government, and sometimes succeeding, which just started the cycle over again. There's a sense that mental illness is worse today, despite how much more we have relative to earlier times. What were the anxiety rates like during the 1930s? Or during the plague? 

Something that's on the edges of the article, but not outright discussed, is our profound lack of in-person community and a loss of the methods to develop connections. 

During the last work-to-rule a few years ago, my students were upset to not have any outlet for their energy that sports offered. I suggested they get their friends together for a game of football or even manhunt in the park! The ensuing discussion made it clear that many of them, if not most, don't have a group of friends. Many don't see anyone outside of school hours - not in person. I suggested getting a few of them to, right this minute, throw a location and time and activity on Instagram, and then be committed to playing with whomever shows up. They tossed the ball back in my court: the schools have to set that up. 


We have stolen the skills of socializing from them as we arranged play-dates as parents and crafted  activities for them in school, to the point that just hanging out and doing nothing with people from class isn't good enough. Their homes aren't impressive enough. There has to be a bouncy castle at least, or pony rides. Part of this is because of the internet, for sure. We don't clamour to go to someone's place because they got the new Billy Joel record, and it's the only way we can hear it until we save up enough money to buy our own copy. But part is from over-scheduling kids and over-entertaining them, so they're no longer ever bored enough to muster the courage to walk next door and ring the bell to see if someone there wants to play. In fact, right now, that once commonplace suggestion sounds absolutely ludicrous! So sports and clubs are necessary, for many, as their only means of connection. But that ends with high-school, and then the inability to find people to hang out with becomes glaring. 

Without those in-person hanging out situations that create our social connections, many have nobody to turn to when they can't quite make rent or have enough food. Or when we need to get organized around a cause, like trying to get schools to encourage masks on everybody. The most stressful situation is made less so when we know we have people who have our backs. I couldn't write as confidently about my concerns with the way Covid is being handled without a group of people on side. Sometimes those connections happen online, where people can find one another through the most obscure interests. But that gamer buddy across the globe isn't going to drop in with soup when you're sick.

In his book On Tyranny, Timothy Snyder gives us 20 simple steps to avoid a tyrannical government. Number 12 is, "Make eye contact and small talk." He calls on us to develop community connections in person, not just for our own sake, but for a healthier society that cares about one another, and one in which we will stand up for each other and march together in the street to change harmful policies and systems. And this, as Carr explains, is what's necessary to begin to create the changes necessary for our own individual mental health. 

I've felt better about the world as I've knocked on doors and talked to real people. There are lots of people who see what's happening in the system and want to talk about it. I've been fortunate to be joined by strong and intelligent people, willing to canvass with me. But I have no idea how to make it less weird to knock on doors just to chat with people without running for office! That's a profound yet absurd barrier for most of us right now.

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