Neither of us are experts in mental health, nor do we have a long history of involvement in radical or democratic health activism. We don’t claim to know everything about these issues. We weren’t around in the 60’s/70’s when movements around democratic mental health really took off in the UK, the States and other areas of Europe, particularly Italy. One of us bought Deleuze and Guattari’s ‘Anti-Oedipus’ four years ago- it’s been a good door stop so far.

However, what we have seen through our initial encounters with mental health activism and mental health organisations and services is a lack of analysis and critique that we have come to expect where our friends and colleagues have engaged in other political, social and environmental issues. Our gut instinct is that mental health, and in fact most kinds of health care, are seen as personal issues that are either best dealt with by professionals or through personal choices such as alternative healthcare, healing or therapeutic communities or alternative self-help groups. In this article we are not pushing for another single issue campaign, or for the exploration of alternatives to mainstream psychology (although we recognise the importance of these). What we are asking is why isn’t health, and especially mental health an issue that we more regularly see as part of our anti-capitalist politics?

Here we want to talk about our own experiences and why we think mental health, when looked at with the same level of analysis as many of the other issues we engage in, should be an ongoing point of conversation for anti-capitalists. We hope to feed into a conversation that we rarely hear in our networks and to find those people who are already talking about these issues politically.

Our experience

The ‘anti-capitalist movement’ we have been a part of in the UK (we offer this definition very broadly and with caution!) constantly strives to create its own infrastructure, whether this is motivated by apocalyptic visions of the future or autonomy from capitalist social relations (or both) everyone’s at it. Squats, housing co-ops and social centres. We build our networks to consist of people who can do accounting, plumbing, squat defending and cooking. We like doing things together and creating our own spaces, and we know how to do it. But for the past too many years we’ve arrived in fields around the UK and Europe, put up some tents, made the running water happen, fought the cops and then… invited a group of ‘action medics’ to set up a tent where we’ll later go to them with our splinters. On the one hand we strive for autonomy and on the other we treat some of our individual and social needs as services to be provided by others. The effect of this is not only that we hand over responsibility and control of our physical and mental health to others, but that we fail to engage with health as a political issue.

For example, in another time and place, some people are starting a transition town group in their local area. In transition town collectives working groups for all the vital aspects of life are set up. This time we remember that health needs addressing. At our first transition town meeting, we attended the health brainstorm. We listened to people discuss the morally deplorable manner with which the NHS disposes of its waste, and casually (probably under-)estimate the amount of plastic that the NHS uses so irresponsibly, “How can we go about persuading them to return to sterilising metal equipment?” Beside providing another example of our obsession with carbon emissions at the expense of social issues, we again failed to identify health as political.

We always seem to forget about health. We talk about authoritarian immigration laws, ID cards infringing on our civil liberties, incarceration of political prisoners (etc. etc.) but a quick look at the health section of Indymedia shows a fine example of the lack of debate there is in our movements around healthcare. There are hardly any posts under the health section of the web page and the ones that are there are mostly concerned with animal rights and incinerators. Why don’t we talk about how capitalism creates mental and physical health problems on both a global and individual level? Or health inequality? Or arbitrary diagnostic criteria that attempt to pathologise the personal burdens we carry from living in such a demanding society?

Mental health and anti-capitalism

When attempts are made to tackle issues surrounding mental health we seem more than happy to tolerate a conspiratorial understanding of society and power that we deplore elsewhere (psychiatrists controlling the masses etc. etc.). The authors believe it makes more sense to understand mental health discourses and practices as largely economically contingent, rather than as the result of some reactionary ideology peddled by a brain washing elite. Mental health practitioners are bound by the same economic limitations and requirements as everyone else, drugs are always the first port of call because they’re cheap, and, as we all know, medical science and research is dominated by pharmaceutical companies because the research just couldn’t happen without their money (significantly the majority of randomised clinical trials undertaken to evaluate the efficacy of drugs versus other forms of therapy are sponsored by the very same companies who manufacture the drugs). But the problem runs deeper than this, historically the industrial revolution facilitated new attitude to ‘madness’ and health, the transformation of nature through manufacture opened the way for ideas about the transformation of people, through transformative therapies and rehabilitation. We saw a move away from the view that madness was an incurable affliction and a move toward therapies intended to ‘cure’ what were now understood as mental illnesses with the view of rehabilitating people back into cooperative and productive members of society. Capitalism requires us to be productive and thus mental health practices and discourses are oriented towards this necessity.

Attempts at reforming mental health services without addressing capitalism inevitably fail. Moves to community care were seen as a great success for the democratic mental health movement in Italy where psychiatric institutions were abolished and all psychiatric and mental health services were outsourced into the community. The eighties and nineties saw a similar move in the UK. Victorian asylums were closed and psychiatric and psychological services were moved into the community. Whereas there is no doubt that psychiatric services are now ‘better’ than they were in the sixties, the failure to challenge the entirety of the system within which mental health services are situated led to what has been described as the mere outsourcing of psychiatric services into peoples homes. The asylums may have gone but the institution hadn’t and couldn’t change.

On a more grass roots level we also limit our potential for change when we revert to DIY life-stylism rather than radically critiquing the health service and the economic system and social processes that produce it. Anarcha-feminists are generally better at politicising health, it was feminists who focused the idea of autonomous health by starting to check their own breasts for lumps. But they also fall into a trap of lifestylism often talking about how to deal with ’so called’ PMT or how to make your own sanitary towels (we hope never to sit through one of these again) rather than how political and economic forces negatively affect people’s everyday experience of healthcare. Why do we never have a radical position on why most health resources are used treating the results of excessive food, alcohol and drug consumption? It’s not enough to encourage healthy, green, organic and active lifestyles or tell people to stop watching telly and get an allotment. In practice this is what doctors try to do everyday in order to lower peoples’ cholesterol and blood pressure, but after years of experience, they know they will always revert to drugs. Similarly it’s one thing to tell someone with high blood pressure to do a bit more exercise and quite another to tell someone suicidal who probably has inadequate housing and may be unemployed to radically change their lifestyle. That just doesn’t cut it for the majority of people. Instead let’s talk about society and what makes it that way.

Consumer and individual choices alone do not carry the antagonistic element that would have the potential to realise change in our society. Whilst this reduction of social problems to the individual diverts attention it also places undue pressure on people who already live in a highly pressurised and externally managed environment. Many attempts at linking Marxist theory and mental health have identified alienation as having psychological or individual origins, but alienation originates from social organisation. Capitalism and the State require us to be active and productive citizens, to embrace our ‘rights’ and responsibilities and to participate equally in liberal democracy. We are dispossessed by society and labelled mad or unfit not then, because we are seen as being ‘possessed’ (as was once the case), but because we are no longer useful. Our focus therefore has to be on this form of social organisation that requires us to participate in limited and pre-determined ways.

This leads us to one other concern, and that is the anti-medical, anti-corporate or anti-progressive streak that dominates some areas of mental health activism. A progressive socially critical position recognises that capitalism manifests in the ways we relate to each other in our everyday activities and not just in the big corporate monster or your local super-market. Rather than throwing the baby out with the bath water we feel that certain technological and social advances, whether that’s drug treatments, medical science or professionalised health services, should be embraced as the product of human creativity and innovation with a valuable and necessary role in society rather than purely as the product of an exploitative capitalist economy. For example rather than shouting down anti-depressants, we should talk about why capitalist economics make antidepressants the best and most ‘effective’ treatment for every person experiencing depression? Instead of criticising health and social care workers, we should recognise the time pressures on their work, the necessary corporate funding that keeps training courses, institutions and research centres afloat and the knock on effect this has on how health services are delivered.

Finally, we feel it’s worth saying here that we are not denying the truly debilitating impact of some emotional and psychological experiences on people’s lives. By saying that mental health has a social and economic dimension we do not intend to belittle the experience of the individual, rather we are asking that our understanding of and activism on health issues has an antagonistic element and a social orientation.

Continuing the conversation

Like we said earlier we’re not pushing for another single issue campaign, rather we’re asking that when we are confronted with issues regarding mental and physical health we see them as political and as part of our struggle as anti-capitalists. Alternative approaches to a range of psychological ‘illnesses’ and experiences exist all over the country, the Hearing Voices Network works with people on an individual and collective level toward finding new ways of understanding and living with experiences of voice hearing. Mad pride and ‘bed pushes’ through city centres are examples of attempts to highlight the injustices experienced in the mental health system and to offer a voice for the ‘dispossessed’ to shout back. But rather than focusing too much on solutions and protest we want to continue exploring how ‘madness’ and health are embedded in social and political processes. We believe that the movement towards a truly democratic ‘mental health’ must be an anti-capitalist movement.

Jane Stratton is involved in the No Borders network, an action medics collective, and studies Medicine.

Lauren Wroe is co-editor of Shift magazine, researches in critical social psychology and is involved in the No Borders network.

The relationship between the WOMBLES and the ESF process has been complex. Our involvement in the social forum discourse started when we were invited to participate in the first London Social Forum (LSF) in October 2003. The LSF had taken a critical position towards the various leftist parties (like the Socialist Workers Party (SWP) and their front group (Globalise Resistance), who had sought to dominate the ESF mobilising process while actively opposing local social forums. It was clear to us that there were progressive attempts to go beyond the hierarchical characteristics of traditional left politics and engage with the rise of anti-capitalism and its subsequent radicalisation on a grassroots level.

Despite our continued scepticism over the origins of the WSF and ESF leadership dynamic, we saw it as a positive step forward, it at least meant that we were engaging with other parts of the political spectrum we had previously been wary of. During this initiative we came into contact with many people who had a passion to organise using consensus and collective decision-making, something in the past that had only existed as a reality within anarchist/anti-authoritarian direct action movements. Though their methodology was different, the experience educated both sides.
Initially enthused by the political openness and direction of the LSF we [as individuals from the WOMBLES] fought hard within the London ESF organising assembly for an inclusive, accountable & transparent process. We had argued in Paris (ESF 2003) that the UK had no grassroots support for a European social forum in 2004 and would be dominated by the retarded political agenda and reactionary forces of the UK Left. This turned out to be prophetic & ultimately true.

We officially left the London organising process when the position of compulsory affiliation fees was imposed from above by the ESF leadership. We have never sought the approval or recognition of the ESF as a body and we make no apologies for our continued critical assessment of the role and function of the ESF as a whole.

The WSF/ESF did not advocate anti-systemic change. It merely asked for “capitalism with a human face”, “a new social contract for global justice”. So, we can see the WSF, and also the ESF, as a new “reformist International”, as “extra-institutional social democracy” which has adjusted itself to the new internationalised politics of capital (and the simultaneous decline of parliamentary politics at the level of the nation state).

Practically, the ESF, as an extra-governmental agent which tries to influence EU policies, must present itself as “a legitimate negotiator”. Therefore, it acts within the limits of present institutions without challenging them at all. Its co-operation with institutions of the status quo, such as national governments and parties, and its condemnation of any anti-systemic movement that radically breaks the imposed limits of social control are manifestations of its compliance.

The synthesis of the ESF is quite problematic. Its main characteristic is “plurality/diversity”, as it results from a drive for inclusivity. This plurality/diversity helps the circulation of different experiences, ideas, struggles. Moreover, it manages to attract people who are starting out in their political activity. So, it seems to have positive aspects. Yet, it unavoidably displays a lack of a comprehensive, common social analysis and common action of participating ESF groups, which in turn drives the ESF, as a body of power, towards minimalist objectives.

Let’s take this point further, differences in analysis suggest different goals in the social struggle. Very briefly, as anarchists/anti-authoritarians, we conceptualise capitalism as a system which develops through two dynamic streams - the first one has to do with “capitalists’ competition”; the competition between capitalist institutions (such as companies), which is grounded on the market economy and leads to “economic development”, to the commodification of every aspect of our lives (vertical expansion) and to the marketisation of every part of the planet (horizontal expansion). The second trend, and more important for us, is “social competition”, the competition between capital and society, related to the historical development of the state (i.e. from the liberal state and its crises to the welfare state/social-democracy and now to the “security networks”/neo-liberal state; from the society of discipline to the society of control etc.).

The lack of such analysis by the WSF-ESF as a whole leads it to the inclusion of organisations i.e. non-governmental organisations (NGOs), which are a-critical and indirectly facilitate capital’s expansion, both in terms of commodification and marketisation (NGOs speak about “under-development” in North Korea and then Nike comes in) and social control (Amnesty International throws the “bombs of ethics” in Yugoslavia and then NATO intervenes). In other words, it leads it to the inclusion of groups and organisations whose actions are not against capitalism at all.

This is to me what we are faced with, an ideological perspective that goes beyond theory, that reaches right within the mindset of the mainstream majority and holds it therefore fearful for change - this is the issue, that change, the idea of change may give us reason to exist, to feel like we are going places, but reconciled with the fear that the security we have and the process of change will ultimately change the familiarity of the power structures we profess to despise. This is the Left, this is our involvement and connection with institutions - from horizontalism to diagonalism, the academic terminology machine launching a thousand PhDs, arguing that power is too complex to solely be classed a binary relationship, them and us- at this point we can only look at our own experiences, we can only know what is right and wrong, not from an analysis that has more to do with who is presenting it rather than what is presented, its neither Callinicos or Negri. When we reach the final hurdle, and are in the last straight, the superficiality of our movement, the subcultures, the terminology, the representation of who are allies and who are our enemies, the movement of movement slowly unravels. Through the facade of solidarity and ‘unity through diversity’ emerge the core deciding factor which dictates and enforces all others - the division between those who deem it necessary to use state and capitalist constituted power and those that seek to destroy it.

The energy and anger and momentum of this ‘movement’ came from the streets of Genoa, Prague, Nice, Evian, Gothenburg, where state forces were happy to teargas us, happy to break our bones as we slept in school buildings, happy to shoot us in the back as we ran away, happy to murder us in cold blood, the very same forces we now go to for funding to hold these Forums, the same forces that “welcome the anti-capitalists” (Jacques Chirac, Paris ESF). The same forces we allow to arrest and beat fellow ESF participants before our very eyes as we make political speeches from the stage under the watchful eye of government employees. The ‘movement of movements’ unravels itself and reveals an empty space.

If government leaders failed to stem the tide of mass anti-globalisation protest on the streets of Europe on a practical level, then it had to be contained by other means. The ESF can be seen as one of those means. In these terms it retains no political legitimacy. Indeed the ‘English exception’ becomes the blueprint.

We took a critical stance against the ESF/WSF not because of the way it was developing but because its central premise was flawed at its inception, incapable, or unwilling, of generating outwards beyond the contradictions that hold it together. When the façade slipped, like it did during those days of the ESF in London, it clumsily revealed the true nature and intentions of the ESF - a party political conference in a safe, controlled environment from which the ESF (through its leadership) could declare itself a credible negotiating partner, not the enemy, of both capital and governments.

The recent discussions on diagonalism represent nothing more than what the WSF/ESF were attempting to initialise from 2002, and therefore what the Leftist apologists of the state try to justify as progressive. Post-modern capitalism has existed due to these discussions of radicality being incorporated into an extensive network of reformist and assimilatory processes, as a mechanism which absorbs discontent rather than radiates it. Diagonalism continues this “proud” history of oppositional recuperation, when pushed hard enough the mask slips and we realise that instead of being a new transcendental force, its interests lie in the maintenance of hierarchically constituted power and the maintenance of the capitalist value system. Our struggle is difficult and risky, it’s best that if we are to risk everything then we should at least do so for everything rather than for nothing.

We leave you with a quotation from another black ski-mask wearing renegade: “I shit on all the revolutionary vanguards of this planet”

The WOMBLES group was started in the autumn of 2000 by a group of anarchists who were inspired and radicalised by a series of serious mass direct action demonstrations in London and around the world at that time. The WOMBLES promoted anarchist ideas, libertarian solidarity, autonomous self-organisation and humour. In 2004 the Wombles were involved with critiquing and organising against the European Social Forum conference held in London. Members were involved with organising an alternative space and occupying the main stage before Mayor of London Ken Livingstone could give a keynote speech. Whilst the Wombles are no longer active, a website is still regularly updated.  http://www.wombles.org.uk/