Bruce Cohen’s Psychiatric Hegemony: A Marxist Theory of Mental Illness offers a comprehensive Marxist critique of the business of mental health, demonstrating how the prerogatives of neoliberal capitalism for productive, self-governing citizens have allowed the discourse on mental illness to expand beyond the psychiatric institution into many previously untouched areas of public and private life including the home, school and the workplace. I recently interviewed him to find out more about his book.
1. I suspect that your book title might well put off the majority of those who study or work in the mental health field. As a sociologist, how would you convince psychiatry-oriented people that they should still take a look at the book?
There are two main reasons. Firstly, because I am concerned with answering the same key questions as they are, including ‘What is the nature of mental illness?’, ‘How do we explain the rapid increase in recent rates of mental disease?’, and ‘Why are the curability rates for sufferers still so low?’. Secondly, like any good social or natural scientist, because my analysis is primarily informed by the available evidence. I think people might have a false impression that I will bang them over the head with hard theory and polemic from the first page, whereas most of the book is actually presenting historical and contemporary research which they will be familiar with and able to relate to. It’s actually quite a fun read, honest!
2. What exactly is ‘psychiatric hegemony’ then?
This is the dominant frame of reference that we use in contemporary society to speak of and understand ourselves and others. I argue that our behaviour, personalities, and lifestyles are now closely observed and judged under a psychiatric discourse which has become dominant and totalising, thus it can be said to have reached ‘hegemonic’ status (that is, an all-encompassing form of knowledge which works to naturalise and reinforce the norms and values of capitalism through professional claims-making). Look at it this way: mental illness diagnoses such as ADHD, OCD, ‘bipolar’, and ‘autism’ have become a part of everyday conversation; they’re now seen as self-evident truths by the general public, and people are often unashamed to declare themselves as having such a mental illness. That is an impressive success for the mental health industry when you consider that only 40 years ago psychiatrists in particular were in crisis over their knowledge-base and treated with great suspicion by the public, there was great stigma attached to mental illness, and the only two mental illnesses that people were generally aware of was schizophrenia and manic-depression.
3. So what changed?
That’s the central question that my book seeks to answer. Some argue that it is down to the intervention of pharmaceutical companies and the American Psychiatric Association’s (APA) promotion of the biomedical model from the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 1980) onwards, some that it is due to the general proliferation of categories of mental illness in each subsequent edition of the DSM and the increasing flexibility within the symptoms of each diagnosis, while others suggest that it is simply a result of the advancements made in the science of mental disease and the improved knowledge among the general public about mental health issues. However, as I outline in the book, the evidence for causation of any mental illness remains poor, as does the existence of any effective treatment. And while there is no question that drug companies have benefited enormously from the APA’s return to the biomedical model, I show through a number of case studies that new categories of mental illness originate from academic psychiatry rather than from big pharmaceutical companies. So my answer as to what changed is that capitalism changed – namely, from welfare capitalism to neoliberal capitalism, from the social state with an emphasis on collective responsibility to a focus on the individual and personal responsibility. I argue that as neoliberalism emerges in the 1970s and progresses over the next four decades, so the psychiatric discourse changes with these new sociopolitical dynamics. Fundamentally, neoliberal ideology demands that individuals be increasingly flexible and productive at work, in school and at work, and the mental health system has been a major conduit towards achieving this goal.
4. It sounds like a complicated argument, how did you go about proving it?
I don’t think it’s that complicated. As an example, anyone who’s looked at the symptoms of ADHD can see that they have nothing to do with having a mental illness but rather denote the requirements for more productive and efficient students and workers (for instance, forgetting or losing homework, failing to complete assigned tasks in the workplace, poor time management, and so on). I am not suggesting some subtle subtext here, it’s in the DSM-5 for everyone to see.
But to answer your question regarding proof, I have undertaken extensive socio-historical analyses of the psychiatric and associated professions (such as psychology and psychotherapy) to understand why they emerged with industrial society as well as to demonstrate how they have tended to follow the dominant norms and values of capitalism in constructing diagnostic categories and theorising human behaviour more generally. Additionally, in my chapters on work, youth, women, and political resistance I have also included some of my own research to demonstrate the changing language used to construct categories of mental disease in the DSM. This textual analysis is useful in further showing the reader how mental illness classifications have come to increasingly reflect the requirements of neoliberalism over time.
5. I can’t say I’m aware of any other Marxist theories in the area of mental health, does this make your book the first?
No, but I think it’s the most comprehensive. I cover a lot of ground, whereas others writing in a similar way have chosen specific aspects of the mental health system or a psychiatry-profession to focus on. I am only talking about a handful of books here by the way, most of which are now out of print. That said, Ian Parker’s Revolution in Psychology (2007) and Ron Roberts’ Psychology and Capitalism (2015) were very useful for my book; I’d highly recommend both to your readers.
6. Finally, are you working on any other mental health projects right now?
Yes indeed. I am just finishing off work on the Routledge International Handbook of Critical Mental Health which will be out later in 2017. It’s a 30-chapter edited volume which aims to bring critical thinking and theories back to the heart of research on mental health and illness. It features many critical scholars that your readers might be aware of such as David Pilgrim, Suman Fernando, Ian Parker, Jane Ussher, Pat Bracken, Sami Timimi, Jeffrey Masson, Phil Thomas, David Cohen, Stuart Kirk, Peter Morrall, and Bonnie Burstow.
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Psychiatric Hegemony: A Marxist Theory of Mental Illness is available from this link. Review copies are available on request from reviews@palgrave.com I
f your institution has a subscription to the Palgrave/Springer catalogue, you’ll be able to download the PDF or eBook versions from there. Bruce welcomes any feedback on his book. He can be contacted by email, b.cohen@auckland.ac.nz, or on Twitter @BmzCohen
Dennis Relojo-Howell is the founder of Psychreg. He writes for the American Psychological Association and has a weekly column for Free Malaysia Today.
