We are not all mentally ill now

In recent years, the terms of mental-health treatment have become part of the mainstream of social policy and political activism. The state of ‘trauma’ – which used to be a doctor’s word for the body’s reaction to severe wounds – has been stretched by psychiatrists to cover the emotional trauma to the psyche caused by abuse or shocking experiences.

Today, as Kenneth McLaughlin explains in his new book, Surviving Identity: Vulnerability and the Psychology of Recognition, the meaning of trauma has been stretched further still to cover all kinds of unhappiness, from losing your job to struggling with childbirth. Similarly, the idea of ‘vulnerability’ has also been expanded to cover many more people, while the state of ‘victimisation’ is seen in all kinds of relations, whether between husband and wife, parent and child, or worker and boss. The mainstreaming of these concepts of psychological harm to cover all kinds of societal relations, over and above the special realm of mental health, was pointed out by sociologist Frank Furedi in his book Therapy Culture (2003), and by Wendy Brown (States of Injury, 1995) and James Nolan (The Therapeutic State, 1998).

McLaughlin was a social worker and part of a mental-health team before he was a lecturer in social work at Manchester Metropolitan University. McLaughlin’s compelling new book looks both at the mainstreaming of mental-health categories, and also the way in which the meaning of mental health has changed. He explains in fascinating detail how the identity of ‘survivor’ has expanded to cover not just Holocaust survivors, but also their children and grandchildren, survivors of domestic abuse and of homelessness. He is particularly insightful on the self-defeating way that the ‘survivor’ identity is sought by people who want to take control of their problems, but ends up making a virtue out of suffering. The status of survivor becomes a platform from which people seek to win resources and recognition from government and others.

Surviving Identity explains the growing theoretical interest in recognition and respect evident in contemporary treatments of Hegel’s philosophy. Hegel saw the struggle for recognition as a key moment in the transition from mere animal existence towards a human need for psychic goods, like honour. But, as McLaughlin argues, the current theory of ‘respect’ goes rather too far in substituting a psychic good for material well-being. It is, he explains, a part of the decline of social struggles over wages and incomes, and the state’s attempts to reconnect with a more individuated citizenry. Sadly, the modern ‘politics for recognition’ does not really offer the chance to win the respect due to a self-confident populace. Rather, it represents a bureaucratic version of respect unrelated to real achievements. That is why the call for ‘respect’ rings so hollow today, and why the word itself is demeaned.

McLaughlin shows how mental health categories have been inflated to embrace a much wider span of the population, as many as a third of all children, according to one claim here. Comparing four editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, McLaughlin shows that the diagnostic categories tripled and the threshold of what counts as a disorder kept falling until it includes embarrassment at meeting people (social phobia).

McLaughlin also explains how the new culture of commanding respect for being vulnerable and surviving trauma impacts on the world of mental health. He shows that a strong movement for the reform of the old asylum system grew up not just within psychiatry, but also without, through pressure from patients’ rights groups organised as ‘psychiatry survivors’, and even a Mad Pride movement (which, if it makes you laugh on hearing the name, will impress you more as you read about it).

McLaughlin gives a very effective account of the ‘anti-psychiatry’ movement of RD Laing, and its premise that what is called insanity might be a proper reaction to an insane world. Of course this is well-covered ground, most recently in a 2008 biography by Laing’s son and – most entertainingly – in screenwriter Clancy Sigal’s very funny autobiographical novel of the time Zone of the Interior (not published back in the Sixties over fears of libel suits, and only put out by Pomona in 2005). For a commanding defence of egalitarian and non-prescriptive therapy, John Heaton’s The Talking Cure (2010) is well worth a look. McLaughlin’s telling of the interaction of anti-psychiatry and survivors groups at a time when once-shaming diagnoses of emotional trauma are becoming a source of pride and identity is very good.

The last chapter of Surviving Identity, ‘the imposition of vulnerable identity’ – with its passages on the ‘legal construction of the vulnerable adult’ – is very striking. It shows that at each turn, the adoption of the language and self-identity of vulnerability leads not to greater status, but to the surrender of more and more rights to the state. Even those who stood up to protest against the rise of Criminal Records Bureau checks of people working with children might be surprised to learn that the CRB also kept a Protection of Vulnerable Adults list, forcing those workers and volunteers to submit to checks, too.

James Heartfield’s most recent book is The Aborigines’ Protection Society: Humanitarian Imperialism in Australia, New Zealand, Fiji, Canada, South Africa, and the Congo, 1836-1909, published by Hurst and Columbia University Press. (Buy this book from Amazon (UK).)