Mental health, depression and capitalism

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By LAYMERT GARCIA DOS SANTOS and ELTON CORBANEZI*

Preface and Introduction of the newly released book

Preface [Laymert Garcia dos Santos]

Elton Corbanezi's book is, in my opinion, a precious study for anyone who wants to know a contemporary phenomenon of great relevance, at the same time social, political and scientific - the epidemic nature of depression and its implications in the management of the so-called mental health of women. populations in the era of globalized neoliberal capitalism.

At first sight, the subject seems arduous, thorny. However, thanks to the researcher's talent and his elegant and fluid writing, the reader will not find it difficult to gradually penetrate the thought-provoking problem. Because Elton Corbanezi takes the time to expose, with precision, the concepts that are unfolding in each other, and against each other, from Renaissance madness to the binomial mental health-depression. A true hermeneutic work, one who interprets texts and the meaning of words, in order to extract and frame this illness so diffuse, so varied, that affects so many people, to the point of alarming those responsible for public health and economic agents .

Everyone knows someone who has had or has depression, if they haven't already gone through that experience. However, few are those who know the full range of its different facets, its different intensities, its incidence in the world of the individual and society. And, even less, those who had the opportunity to trace the “problem”, the way depression was built in theory and social practice. This is the route traced by the author, this is the greatest quality of his investigation.

Relying on a first-class bibliography, where Michel Foucault, Nietzsche, Gilles Deleuze, Georges Canguilhem, Robert Castel, the English antipsychiatrists, Franco Basaglia, Alain Ehrenberg, Erving Goffman, Thomas Szasz and many others (including studies of Brazilian authors) – from Machado de Assis to Joel Birman and Jurandir Costa Freire, passing by Vladimir Safatle…), the researcher traces the cartography that goes from madness to classic unreason, from this to mental illness and, finally, from illness to mental health, showing how this it has as a correlate the impressive advance of depression and its management outside the asylum institution, in the open field, through the increasingly emphatic use of biochemical treatments.

If Elton Corbanezi had limited himself to such mapping, he would have already done a great service, by cleaning up the area and showing the transformations that occurred in the field of psychiatry as a defining science of who is sane and who is insane, who suffers or not from mental disorders. But the merit of the research goes further, in that the author permanently keeps an eye on the evolution of medical theory and practice and another on the way these are articulated with the management of individuals and populations by power. Thus, the analysis of the past clarifies how psychiatry was constituted as a technology of power over the abnormal before becoming one of the main vectors of normalization itself in contemporary society. That is to say: large-scale production of subjected subjects.

And that is where the present work raises an acute interest, by showing the intrinsic and perverse relationship that is established between the depressive and the loser in a neoliberal society that makes competition penetrate all the pores of individual and social life. Indeed, rescuing Michel Foucault's analysis of the neoliberal version of homo economist and by Osvaldo López Ruiz on the individual reduced to “human capital” and “self-entrepreneur”, the author makes us realize that the imperative of generalized mental health, advocated by the American Psychiatric Association and by the reports of the World Health Organization, does not it is but the other side of the coin on which epidemic depression is inscribed.

Introduction [Elton Corbanezi]

The objective of the book is to show the political and economic function that is inferred from the articulation of two contemporary scientific notions: mental health and depression. More specifically, from a historical and conceptual perspective, we critically analyze the provenance and consolidation of the mental health discourse in the second half of the 1970th century, then presenting elements to sociologically understand the current idea of ​​the depressive epidemic , disseminated in the social imaginary of Western capitalist societies since the XNUMXs and officially supported today by the World Health Organization (WHO).

It is known that Foucault thought the present from history. In watch and punish, the philosopher called this task “history of the present” (Foucault, 1987, p.29). If, on the one hand, our intention is to apprehend the contemporary concept of mental health from a historical perspective, on the other hand, a different notion from the author of history of madness encourages us to reflect on depression as a current sociological problem. As we do not know whether or not the epidemic proportion of depression reported today corresponds to the end – or the beginning – of a historical time, the question about what we are doing with ourselves today becomes urgent. “Ontology of the present” is the way in which Foucault (1994, v.4, p.687-8) conceptualized this risky and necessary experience of apprehending the contemporary, which had been inaugurated by Kant through his questions regarding the Enlightenment (Enlightenment) and the French Revolution. Moved by this challenge, we ask: what can depression, as a problem highlighted by the positive discourse on mental health, say about us and what we are doing with ourselves today?

It is true that the symptoms that currently make depression an illness go back a long way. In his presentation to “Problem XXX, 1” – a text in which Aristotle explores the relationship between inconstancy and exceptionality, characteristic of the genius of the melancholic –, the philologist and historian of medicine Jackie Pigeaud argues that Western tradition conferred on Hippocrates the establishment of melancholia like disease. According to Pigeaud, in the 23rd aphorism of book VI of Aphorisms, attributed to Hippocrates, is the following thought: “If sadness (dysthymia) and fear last a long time, such a state is melancholic” (Aristotle, 1998, p.55). Despite its distant origin, as well as the different conceptions of melancholy that have been established throughout the history of Western medicine, depression, as a possible update of this state of mind, can be considered a social phenomenon relatively new: its significant increase in the world epidemiological indices occurs, above all, from 1970 onwards, when it starts to be publicized as the “fashionable disease”, the “disease of the century” or even, according to the famous formulation of Freud (2010 ), the current “discontents of civilization”. This is what French sociologist Alain Ehrenberg says in the interview “La dépression. Naissance d'une maladie”:

In the first half of the 1970th century, depression was just a recognizable syndrome in most mental illnesses (psychoses and neuroses), and it is not the object of any particular attention in our societies. Everything changes in the 2004s. Psychiatric epidemiology then shows that it is the most common mental disorder in the world, while psychoanalysts perceive a clear growth of depressed patients among their clients. It's your medical success. On the other hand, depression is propagated by the media as a “fashionable disease”, or even the “disease of the century”. That is, the depression is less new than its magnitude. It ended up designating most of the psychological or behavioral ills that everyone is likely to encounter in the course of their lives. Thus, depression becomes a sociological success. (Ehrenberg, 34a, p.XNUMX)

As can be seen, since the last three decades of the twentieth century, this psychiatric disorder has become a medical and sociological problem of the first order. According to World Health Report 2001 – Mental health: New thinking, new hope – WHO document aimed exclusively at mental health problems – around 450 million people on the planet suffered, around 2001, from mental or neurobiological disorders. Within this framework, severe depression already appears in the report as “the main cause of disability worldwide and ranks fourth among the ten main causes of the world's pathological burden” (WHO, 2001, p.14). Faced with such a scenario, the publication highlights the relevant and well-known prognosis that depression would become, by 2020, a worldwide epidemic problem, rising to second position in the ranking of the main causes of the world's disease burden, which is assessed according to disability-adjusted life years (DALYs); therefore, depression would be second only to ischemic heart disease (ibid, p.57-8). In a 2008 publication, focused on the global burden of disease, the WHO projects, however, that depression will become the first in ranking by 2030, surpassing heart disease, the consequences of traffic accidents and cerebrovascular disease (Idem, 2008, p.51). Considering this panorama, we formulated our question: in relation to what and in what way does depression present itself nowadays as an epidemic problem?

A whole tradition of Western philosophical thought – notably Nietzsche, Canguilhem, Simondon, Foucault, Deleuze and Guattari – has already shown how much the pathological is a problem that can be reflected only according to a relational multiplicity, more specifically a problem that is established from the relationship with normativity, be it language, physiology, the individual, the environment or the social fabric. The radical nature of this point of view is noted, for example, in the philosophy of the biological normativity of the organism conceived by Canguilhem (2002), according to which there is no biological fact – neither individual nor social, therefore – that is normal or pathological in itself. Inspired by this tradition of thought, it is in a relational way that we seek to examine (i) the constitution of mental health (as a concept and field of activity) and (ii) the current idea of ​​the depressive epidemic. Seriously considering the proposition that depression cannot be thought of as a natural, ahistorical or per se datum, but only in relationship, it is clear that it can become a disease with a very high incidence, as it constitutes a problem for a certain way of life and all the requirements that follow from it, such as happiness, enjoyment, energy, creativity, speed , projection, motivation, communication, mobility and so on. While the opposite of certain normative ideals of contemporary capitalism, the depressive experience seems to present itself as a significant manifestation of obstacle and refusal to the biopolitical imperative that characterizes the operational mode of mental health.

Hence the need to map and understand the emergence and consolidation of the concept of “mental health” in the second half of the XNUMXth century. Result of a broad process of deinstitutionalization of mental illness in different western countries, as well as the institutionalization of human rights, the development of psychopharmacology and the incorporation of the mental element in the WHO concept of health, the mental health discourse establishes central objectives such as replacing the hospital-centered model, humanize and prioritize treatment in primary care, prevent and destigmatize mental disorders and promote mental health.

However, unlike concepts such as “mental illness” and “abnormality”, which refer, respectively, to the pathology itself and to its virtuality, the concept of “mental health” ranges from psychosis and the various psychic sufferings to the production of mental illness. well-being. We will see, therefore, that the extension of the concept of mental health provides and supports a significant psychiatric intervention in the social fabric, making it possible to stimulate and enhance the performance and effectiveness of conducts in a society that increasingly "de-collectivizes" the individual and attributes to him responsibility for their social success or failure.

Since the 1970s, approximately, we have witnessed the emergence and intensification of events that are still contemporary with us and that require a relational approach: it is alongside the “neoliberalization” of Western societies that the mental health discourse begins to take consistency and suggest a meaning different from the one initially intended during the welfare state (welfare state), at the same time as the paradigm from which mental disorders are conceived is modified and depression is trivialized through the dissemination of its epidemic.

By problematizing scientific notions in political terms, we mean that the configuration and definition of the concepts of mental health and depression can be articulated in such a way as to modulate existences and govern behaviors. As Deleuze (1992, p.203) stated about Spinoza, the concept, whatever it may be, does not move only in itself, but also in things and in ourselves. That is, unlike isolated and innocent, the concept always implies life. It is in this sense that we present the proposition that the concepts of mental health and depression can have a political function on existence in contemporary capitalism.

* * *

Before directly problematizing the notion of mental health, the first chapter intends to historically reconstitute the emergence of the concept of mental illness, which conditioned the birth of psychiatry. In line with Robert Castel's thesis (1978, p.272) on the model role that French alienism played in different Western countries, the exposition regarding the constitution of psychiatry refers to the French prototype based, above all, on research by Foucault and Castel himself.

However, the purpose of the chapter is not to meticulously explore the history of the birth and constitution of psychiatry, as the aforementioned research has already remarkably done, but rather to highlight and analyze the different concepts related to psychic and behavioral disorder. In this way, we go through a history whose beginning precedes the very constitution of psychiatry, with the purpose of underlining the transience of the concepts of “madness” and “unreasonableness” until the construction of “mental illness”. Proceeding in this way, it is a question not only of showing the formation of the paradigm of hospitalization in force until the second half of the XNUMXth century – given that it is through the relative deconstruction of such a paradigm that the emergence of the field called mental health arises –, but also of highlighting , from a genealogical perspective, to what extent conceptual transformations correspond to true modifications of problems. In this sense, we emphasize how the concepts of madness, unreason and mental illness operate significant shifts, as do the concepts of abnormality and mental health later on.

It is with the same procedure that we examine, in the second chapter, the provenance, emergence and consolidation of the contemporary concept of mental health. To do so, we analyze the implications of the concept of abnormality in psychiatry, as well as the criticisms and contestatory and anti-psychiatric movements directed at the traditional paradigm of psychiatry based on hospitalization.

Then, we resort to both sociological, philosophical and medical research on the concept of mental health and WHO documents that define and disseminate it officially and worldwide, in order to understand its latent and current political function.

Finally, the third chapter examines the idea of ​​a depressive epidemic. It starts with a literary testimony to draw attention to the seriousness and gravity of severe depressive suffering. Then, to show that suffering is not always of such intensity, we investigated the evolution of the conceptions of depressive disorders in the successive Diagnostic and statistical manuals of mental disorders (DSM), especially from the third edition, which changed the paradigm of psychiatric rationality.

In more detail, we analyzed the various diagnostic categories of depression in the last two editions of the American Psychiatric Association (APA) manual: the DSM-IV-TR [2000] and the DSM-5 [ 2013], which are, alongside the International Classification of Diseases (ICD) of the WHO, the main classification systems of psychiatry in the world. Finally, we present the theory of human capital as an essential characteristic of the ethos contemporary of western capitalist societies, in order to identify, then, how the scientific evolution of the psychiatric nosology of depression can be related to the demands of current capitalism.

We will see, therefore, that the idea of ​​a depressive epidemic can have as a condition of possibility the contemporary context of the biopolitics of mental health. In this sense, the history of depression as a clinical category interests us less than its relationship with the positive discourse of mental health – hence examining the psychiatric conceptions of the disorder from the second half of the twentieth century. Describing and analyzing the systematic ramification and flexibility of depressive disorders in psychiatric manuals, the central hypothesis of the book is that the establishment of depression as a pathology, especially in its most tenuous form, corresponds to the logic of performance that underlies a form of government focused on development , the optimization and empowerment of individuals' capabilities.

We intend to maintain, therefore, that the idea of ​​a depression epidemic makes sense when related to an external discourse that permanently encourages the individual to produce well-being, to optimize his capacities and to self-realize in all dimensions of sociability. That is, depression, according to the current psychiatric conception, seems to constitute a relevant problem for Western culture, especially in relation to a way of governing life that constitutes the positive program of mental health.

As can be seen, we argue that there is a articulation fundamental link between the idea of ​​a depression epidemic and the emergence of mental health, which results, contrary to what the criticism of the classic psychiatric device intended, in the expansion of medical intervention with the tacit objective of inciting and promoting the powers of individuals in all spheres of social life (interpersonal relationships, family and work). Thus, in the context in which it is intended to produce a certain health at all costs, the supposedly epidemic proportion of depression can highlight – and call into question – the political aspect of a program that circulates in the name of health.

By establishing the neoliberal context of the biopolitics of mental health as a condition for the possibility of the depressive epidemic, it is not a matter of carrying out a mere sociological reductionism, as if the conception of depression was constituted exclusively from contemporary social norms. If, on the one hand, reducing such a medical phenomenon to the biological dimension consists of naturalizing something that is also socially, culturally and historically produced, on the other hand, limiting it equally to a sociological explanation implies neglecting depression as an event that calls for the investigation of various types of knowledge. .

As Pignarre (2003, p.125-6) warns, it is less a matter of subordination than of mobilization of knowledge, since depression inevitably and simultaneously involves biological, psychological and social elements. Despite the incontestable aspect of this observation, it is up to sociology – among several possible paths and together with other human sciences – to research in documents that guide medical and social practice the political-economic function of institutional discourses and scientific classifications. In time, it is necessary to warn that the reader will not find here, therefore, an investigation into the physiological or psychic functioning of depression, nor regarding the practices that affect it or regarding the financial interests of the pharmaceutical industry.

In our view, problematizing “mental health” and “depression” from a historical and conceptual perspective implies removing from them the aura of disinterested scientific truth and denaturalizing them, which is a fundamental task of sociology. That's why we need to deal with the issue: the mental health discourse and the establishment of depression as a disease can operate as a social symptom, showing what society projects in terms of health and what it pursues as pathological.

*Laymert Garcia dos Santos he is a retired professor in the sociology department at Unicamp. Author, among other books, of Politicize new technologies (Publisher 34).

*Elton Corbanezi is professor of sociology at the Federal University of Mato Grosso (UFMT).

Reference


Elton Corbanezi. Mental health, depression and capitalism. São Paulo, Editora Unesp, 2021, 248 pages.

REFERENCES


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Aristotle. The Man of Genius and Melancholy: the XXX problem, 1. Translation by Jackie Pigeaud; Alexei Bueno. Rio de Janeiro: Lacerda Editores, 1998.

BIRMAN, Joel. Psychiatry as a discourse of morality. Rio de Janeiro: Grail, 1978.

CANGUILLEM, Georges. The normal and the pathological. Translation by Maria Thereza Redig de Carvalho Barrocas; Luiz Octávio Ferreira Barreto Leite. Rio de Janeiro: University Forensics, 2002.

CASTEL, Robert. the psychiatric order: the golden age of alienism. Translation by Maria Thereza da Costa Albuquerque. Rio de Janeiro: Edições Graal, 1978.

COSTA, Jurandir Freire. History of psychiatry in Brazil: an ideological cut. Rio de Janeiro: Garamond, 2007.

DELEUZE, Gilles. conversations. Translated by Peter Pál Pelbart. São Paulo: Editora 34, 1992.

EHRENBERG, Alain. La dépression. Naissance d'une maladie. Our story, Paris, n.285, p.34-6, mars 2004a.

FOUCAULT, Michael. watch and punish: birth from prison. Translation by Raquel Ramalhete. Petropolis: Voices, 1987.

FOUCAULT, Michael. Dits et écrits 1954-1988. v.1, 2, 3, 4. Paris: Gallimard, 1994.

FREUD, Sigmund. Civilization's Discontents. Civilization and its Discontents, New Introductory Lectures to Psychoanalysis and Other Texts (1930-1936). Translation by Paulo César de Souza. São Paulo: Companhia das Letras, 2010. p.13-122.

HACKING, Ian. What is the social construction of what? Barcelona: Ediciones Paidós Ibérica, 2001.

MACHADO, Roberto et al. damnation of the norm: social medicine and the constitution of psychiatry in Brazil. Rio de Janeiro: Grail, 1978.

WORLD HEALTH ORGANIZATION (WHO). World Health Report 2001 – Mental health: new conception, new hope. 2001.

WORLD HEALTH ORGANIZATION (WHO). Global Burden of Diseases: 2004 update. Geneva, 2008. Available at: https://www.who.int/healthinfo/global_burden_disease /2004_report_update/en/.

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PIGNARRE, Philippe. The Depression: an epidemic of our time. Translation by René Palacios More. Barcelona: Debate, 2003.

 

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