Last week, I attended an evening presenting Richard Layard and David Clark’s new book Thrive: The Power of Evidence-Based Psychological Therapies hosted by Action for Happiness, which Layard co-founded. Underlining the core thesis of their book, Layard and Clark spoke about the immense potential for evidence-based psychological therapies to alleviate the burden of mental illness in the UK; if only we invested more in these services. They encouraged us to write to MPs to ask Commissioners to do so. This is in the tailwind of Mind releasing a report last month in which Local Authorities were rightly lambasted for spending ‘unacceptably low’ amounts on mental ill-health prevention services. While funding for mental ill-health represents only 1.36% of the national budget, we spend four times as much on anti-smoking initiatives. Yet suffering from mental illness can shorten lives more than smoking and is the single largest source of burden of disease in the UK.
This demonstrates the terrible inequality between the way we treat physical and mental illnesses that must cease. Spending on provision for mental health needs to be ramped up to high volume. Agreed.
What concerned me about the Thrive event, however, was a feeling that we were skirting around the core issue – that is, the political and economic background against which the mental health crisis has exploded, has itself thrived. It is no coincidence, in my mind, (and many already agree), that we have seen the escalation of mental health problems coincide with the rise of a neoliberal political ideology that, since the 1980s, has promoted individualism, competition, commodification, marketisation, and privatisation of common goods and services. The Joseph Rowntree Foundation has found that the resultant visible securitisation of our physical environment in cities and towns has created a pervasive culture of fear and anxiety, undermining trust and social cohesion further, and contributing to mental illness. A report published in 2010 by the Mental Health Foundation directly links mental ill-health to our individualistic society. We are the one of the most unhappy, distrusting, and lonely countries in the world, with one of the highest rates of self-harm in Europe.
At the same time, we have seen the welfare system hacked back, with direct implications for those struggling with mental ill-health. Last year, Mind reported a 50% increase in the number of calls to its Infoline, according to the Guardian, with callers reporting severe financial worries. Oxfordshire Mind received £336,078 (I am curious how the £8 was decided on…) from the Big Lottery Fund to deal with some of this fallout through its Benefits for Better Mental Health service. The recession has been found to have hit those with mental illness hardest, with fears for the impact on yet further social exclusion. How can we talk about calling for more funding for mental health without talking about austerity and health privatisation and what the broader ideology behind this is doing to our societal capacity for wellness?
Take social anxiety; the most common anxiety disorder, which David Clark spoke about at the launch. Social anxiety relates to an excessive level of self-consciousness and fear concerning what others are thinking about you, leading to avoidance or intense anxiety of social situations. A social dis-ease. As a very shy young person, I experienced this myself and know how crippling it can be, even far into adulthood. There are many things one can do – investing in more access to Cognitive Behavioural Therapy to ‘correct’ thinking and put it into perspective is one (although this approach itself requires critical examination). But, shouldn’t we be asking, what kind of society creates this condition in the first place? Why are we so afraid of one another? Or, perhaps, why have we not made space in our society for shyer more reserved peoples (worryingly, Social Anxiety Disorder reaches back to concepts of shyness in its historical development) – something that Susan Caine, in her book Quiet: The Power of Introverts in a World That Can’t Stop Talking, deems to be the result of a cultural ideological ideal of extraversion, which fits hand in glove with our other cultural holy grail of brash individualism and competition. Perhaps we should look at social anxiety as a symptom of the cultural myth of the confident, self-made individual clamouring for recognition, which has no time for the quiet, the uncertain, or the not-yet fully formed, fully ‘self-branded’ person. For this reason, perhaps it is no surprise that Social Anxiety Disorder is most common in the young – particularly those in their 20s.
Describing how psychological therapies can help such conditions, and many others, Clark concludes that a ‘large proportion’ of mental health problems are often solved by someone simply listening and being sympathetic. Hang on a minute… Rewind… ‘…are often solved by someone simply listening and being sympathetic.’
If that is true, then shouldn’t we be asking – what’s going on with us that we don’t provide that for each other? Why must I go to a therapist to have this basic human need and capacity offered to me? In a society dominated by so-called ‘communication skills’ and communication technologies – have we forgotten what it means to listen? Do we not know what it’s like to be heard until we enter a therapy room? How tragic. I can’t help but feel that our capacity for true empathy (I dislike the word sympathy) is swallowed up by the ticking clock, the over-bombardment of advertising and images, and the relentless me-first mentality that we are led to believe is necessary to ‘win’. Only those we pay have the time and skill, or perhaps the permission, to listen. For to admit that we are mentally unwell is to admit that we are not so sure that we are ‘winning’. And to listen to another – to truly hear empathetically – is to perhaps admit that neither are we…
According to George Monbiot in a recent Guardian article, this ‘Age of Loneliness’ – of individual striving and surviving – is killing us. Loneliness is a significant cause and augmenter of mental health problems, as well as factor contributing to reduced life expectancy. Monbiot attributes its pernicious prevalence to that ‘life-denying’ neoliberal ideology that ‘enforces and celebrates our social isolation. The war of every man against every man – competition and individualism, in other words – is the religion of our time, justified by a mythology of lone rangers, sole traders, self-starters, self-made men and women, going it alone. For the most social of creatures, who cannot prosper without love, there is no such thing as society, only heroic individualism. What counts is to win. The rest is collateral damage.’
Echoing similar analysis, Action for Happiness state on their website: ‘We live in an increasingly competitive, self-obsessed culture which encourages us to pursue wealth, appearance, status and possessions as a route to success. This is supported by our political and economic systems that are focused on maximising economic growth above all else… [O]ur focus on materialism and self-obsessed individualism is leading to serious problems across society. We’ve seen huge increases in anxiety and depression in young people, greater inequality, more family breakdown, lower levels of trust, longer working hours, growing environmental problems and crippling levels of debt.’ At the same time, Layard and Clark write in their book that ‘mental illness does seem to be more common in countries where there are low levels of support, trust, and cooperation, and excessive levels of competition for position’.
But both Action for Happiness’s and Layard and Clark’s response is woefully, inadequately non-political – ‘By focusing our time and energy instead on things that have been shown to consistently bring happiness we can live rich, rewarding lives. These things include loving families, close friendships, good self-awareness, strong community ties, helping others, meaningful activities, keeping active, and having a spiritual dimension or greater purpose to our lives.’ In one swift movement, Action for Happiness brings us to the brink of the structural problem, and then whisks us away into the private realm of personal and family life, where it is promised that ‘small actions’ will ‘build a happier society’ and a ‘social movement’ for change.
In a similar vein during the event, Layard argued that of course we need to address attitudes and social values, moving away from competition, consumption and material status aspiration. We must foster communities that put altruism at their core to counter these forces. As if to initiate this, the Chair, the Director of Action for Happiness, was anxious to keep encouraging us to ‘think of small actions we can do ourselves’ to make the world happier, asking us to write a ‘pledge’ on the back of a small credit-sized card we were each given on our seats. If only these personal credits could outweigh the structural debts on the balance sheet.
Of course small actions matter – they matter to people here, now, the starfish that was put back in the sea; but this perspective ignores the conditions that structure our responses. How can we create an altruistic, meaningful, spiritual, community-minded society in the context of vast inequality, insecurity, and the creed of competitive individualism that is ingrained in the logic of our institutions, even within our infrastructure? The GREAT DREAM of the ’10 Keys for Happier Living’ that Action for Happiness promotes is curtailed and crippled by the very economic and political structures that had to dream it. Our capacities for Giving, Relating, Exercising, Appreciating, Trying out, Direction, Resilience, Emotion, Acceptance, and Meaning are all socially defined and constrained.
Neither altruism, nor small personal actions, can ever be enough if we’re talking about the scale of change we need. It is like being told to eat a healthy diet in the face of the billions spent on advertising junk food to halt obesity… Or putting little pictures of blackened lungs and rotting corpses on packets of cigarettes to prevent cancer… Or telling us to switch off our lights and unplug our mobile phones to prevent runaway climate change… Or investing more into psychological therapies for those struggling with mental ill-health… They are good things to do, but they don’t solve the root problems; rather, conceal them.
This obfuscation is duplicated in Layard’s own analysis – he argues that the majority of those who are least satisfied with their lives are most likely to be suffering from a form of mental illness, which itself causes more misery than poverty or unemployment. Whilst definitely seeking to reject the pathologising of sadness and wanting more from life, isn’t long-lasting dissatisfaction and unhappiness often a cause of mental illness? And physical illness, poverty, and unemployment are all factors that significantly increase the likelihood of developing mental health problems as self-reinforcing factors. Comparing the suffering caused by mental illness to that of poverty is a misnomer – mental illness emerges out of a whole combination of layered factors, including poverty or unemployment itself, and is often a symptom not itself a cause. This shows up the danger of simply focusing on treatment and not prevention or the wider causes for its manifestation. If we segregate mental illness from factors such as poverty, unemployment, and social fragmentation, we wind up in an apolitical situation in which ‘happiness’ simply becomes a thing that we try to create in our spare time, rather than seeking to build a conception of mental wellness into the very logic of our social system.
Layard says that we need to rethink the concept of ‘deprivation’ to reflect what is going on inside someone’s own mind – for mental illness spans income inequalities and socioeconomic backgrounds. Both poor and rich can suffer. Yet, pinpointing mental illness as an individual phenomenon again misses the point – this is a social, structural crisis, not just a personal one.
Wanting to appeal to a wide audience, Action for Happiness state that is has ‘no political, religious or commercial affiliations’. This is bigger than party politics; that is true. Yet, stopping short of challenging the neoliberal logic we find ourselves forced into, it only ends up standing by the political, dogmatic, and commercially-minded ideology that is framing the existence of this social movement in the first place.
The mental health crisis should be understood as a social limit to growth – that is, a social warning system sounding the alarm against the relentless pursuit of endless economic growth within the current paradigm, as Action for Happiness themselves seem to recognise. But if we are serious about, say, Gross National Happiness as our measure of progress, then we must recognise that this entails a supremely radical shake-up of our entire economic model and cultural ideology. At its logical endpoint, we are talking about challenging the very ideology of growth itself. As Monbiot concludes, ‘Yes, there are palliatives, clever and delightful schemes like Men in Sheds and Walking Football developed by charities for isolated older people’ (And isn’t ‘Action for Happiness’ just such a palliative?) ‘But if we are to break this cycle and come together once more, we must confront the world-eating, flesh-eating system into which we have been forced.’
I am not sure whether Action for Happiness, or indeed Layard and Clark, are aware that their stated ambitions, to create a ‘happier society for everyone’, and a ‘positive change in what we mean by progress’ away from ‘materialism and self-obsessed individualism’, are much more radical, and political, than they themselves perhaps wish to admit.
In the last sentence of their book, Layard and Clark say that with regards to mental health ‘Apart from global warming, there is no other major problem which is so neglected worldwide.’ I agree – and would add that both are at root the same problem; as one audience member put it – a system that itself is psychologically unwell, in the manner of Joel Bakan’s pathological corporation. The solution to both can only be system-level change – a confrontation with the fundamental neoliberal logic of our entire current mainstream politics and economics. What could be more radically political – and more mentally sound – than that?
 As an aside – I am always amused and irritated in equal measure by such turns of phrase as ‘mental health prevention services’ or, in chit-chat, ‘she’s got mental health’ – as if people being well, that is mentally healthy, is the thing that is bad. Let’s get it right – we’re talking about mental illness not wellness here, sadly.