Mental Health Is Not an Individual Problem

Micha Frazer-Carroll on how the world de-politicized the brain.

How did we get to a place where mental health is treated as a purely individual problem, not one that can be addressed politically? The history of the de-politicization of mental health is fascinating, which is why I was excited to talk to Micha Frazer-Carroll, the author of the new book Mad World: The Politics of Mental Health. In the book, she traces the history of leftist mental health movements, and attempts to re-politicize the struggle over our own internal states. 

You experienced a bad bout of depersonalization and anxiety, and that led you to wanting to investigate the underlying causes of your own mental health issues right? 

When I was 21 I had this experience of depersonalization, which basically is when you feel like you aren’t real. It kind of feels like being really, really hung over. Or like you’re watching life through a TV screen, like you’re an observer. It felt very philosophical at times—looking in the mirror and feeling like I didn’t recognize myself. Just totally detached. Depersonalization is almost always accompanied by really severe anxiety. That was really difficult. I was having panic attacks multiple times a day. I was really unwell.

It was after that, in the years following—I did a lot of writing about mental health, and over the years, the way I thought about that experience kind of shifted. I found new context for that experience. I had been really isolated. I was at university and on so many deadlines. And I’d had a few traumatic experiences at the time. And I didn’t really have a community. So I started feeling like it was really important to name those political and social conditions I was facing. 

Mental health is often so depoliticized these days. Is that something you wanted to push back against?

Over the course of the 20th century, we saw this shift, especially after the first DSM came out, to this very biological, individualist way of thinking about mental health—that it’s something that exists within each person’s brain and not really thinking about how it connects to political and social conditions. People began saying things like “it’s an illness like any other,” and totally detaching it from the social world.

In reality, it can’t be disentangled from capitalism, racism, transphobia—all these causes of suffering. But simultaneously I wanted to point out that this isn’t unique to mental illness—all illness is political and connected to our way of life and our oppressions.

Why does the way we talk about mental health matter—whether we say it’s individual or societal? What’s wrong with saying “it’s just a chemical imbalance.” 

I think it leads to us not being able to connect our struggles to each other. We need to be connecting to each other and joining in solidarity with other people who are suffering. We need to be connecting to antiracist movements, anti-carceral movements, with the feminist movement. All of these struggles are extremely connected. When our oppression leads to suffering and distress, and then we choose to name it as just a chemical imbalance, we basically fracture those ties of solidarity. It prevents us from forming an analysis about our conditions that could actually lead to political transformation.  

It’s also just quite a self-blaming approach—it leads people to feel quite isolated and individually responsible for their own suffering. 

Awareness is the big thing that everyone—the media, governments, celebrities—talks about these days. But what do we do after we’re aware?

It’s something I interrogate a lot—aware of what? The idea that there’s objective mental health knowledge we should be aware of is quite insidious. And it’s often used as a way of propping up and circulating traditional psychiatric knowledge. It’s always awareness of symptoms and traditional psychiatric cures, not the underlying problems that are causing us to be depressed or anxious. 

Within awareness narratives, we also put the onus on individuals to solve a mental health crisis. If we all just speak up individually and get help individually and break the stigma individually—and all of this is just demands on individuals rather than on bigger systems or the state. 

It also turns mental health into something that’s very understandable and digestible. In the U.K. we have this phrase of the “black dog of depression” or the “dark cloud of depression.” All of these statistics and metaphors that attempt to boil it down to something very digestible. When in reality, mental health is really messy, and affected by our communities and circumstances. Being able to hold that nuance and messiness is important. 

It’s interesting that a lot of this feels controversial on “the left” now. Being skeptical of psychiatry and the frameworks around mental health used to be a big part of being on the left.

In the 1960s, during the Civil Rights struggles and feminist struggles and all these counter-hegemonic movements, there was also an anti-psychiatry movement, which paradoxically was partially led by a lot of psychiatrists themselves. There were right-wing psychiatrists and left-wing ones that were part of that movement, but what united them was challenging the very basis of psychiatry. They weren’t only challenging the institutions like mental hospitals and prisons but also the idea of mental illness itself. As Sami Schalk wrote in Black Disability Politics, the Black Panthers had a lot of connections to this movement. Many of them had been institutionalized in psychiatric hospitals as part of the government crackdown on the movement.

There were all of these ideas challenging psychiatric power and they were all kind of linked up. And now that’s not really there. The history of these movements is no longer well-known, even in very political spaces or even disability justice spaces today. 

Why has mental health become so depoliticized these days?

I think it has a lot to do with the general neoliberalization of everything. In the mid-20th century you have all of these state systems in control of things—many people spent half of their lives institutionalized in psychiatric facilities. When deinstitutionalization took place under Thatcher, Reagan and similar politicians—when you look at that historical shift, you also see a shift in the way mental health is talked about. In 1980, you get this new edition of the DSM that’s much more individualizing and about internal disease and disorder. And that happened at the same time as this state disinvestment. The message was: it’s your responsibility as an individual actor to bring your minds and behavior back in line with the demands of the state and the labor market. And that’s where we get the “reach out, speak out, break the stigma” narrative. 

Now it’s more prevalent than ever—people talking about they’ll only date people in therapy. Everyone’s on Headspace or other apps. Everyone’s journaling. And it’s not that these things are bad, but the emphasis is always on the individual—it’s you who has to do something about it.