Mental health and well-being

Image: Ekaterina Astakhova
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By ELTON CORBANEZI*

Mental health, pandemic, precariousness: neoliberal subjectivities

The relationship between mental health, the Covid-19 pandemic and precariousness seems explicit. There is no doubt that the mental health of individuals has been harmed in the context of the Covid-19 pandemic, which has devastated the world since 2020; nor that the processes of precariousness of life have been intensified in the course of such an event, especially in countries where neoliberalism appears as an economic policy and form of social organization.

The apparent evidence in the relationship between the terms conceals more complex sociological and historical issues. The purpose of this article is precisely to submit such terms to critical sociological analysis, in order to relate and problematize them based on their historical and social constructions and implications and, in particular, based on the contemporary processes of neoliberal subjectivation that they cross.

As for mental health, the aim is to show how such terminology became common and everyday from the neoliberal appropriation of criticism of psychiatry, politically perceived until then as conservative of the social order.[I]In general, in everyday life, the use of the term mental health occurs, paradoxically, to refer to the absence of it. The Covid-19 pandemic, in turn, significantly intensified not only the production of psychological suffering and mental disorders, but also attributes specific to neoliberal subjectivation, such as full availability for work (for those who have it available), hyperproductivity , instant communication, competition and social, digital and mental acceleration.

If material and objective precariousness is nothing new since the establishment of modern capitalism, intensifying more and more, subjective precariousness has become a dominant characteristic of the hegemonic way of life in societies based on neoliberal rationality.[ii] Once again, we are not facing “only” the psychological suffering resulting from this form of organization of social life, but also the normative establishment of a way of life that comes from above.

Flexibility, instability, risk-taking: a form of precariousness – understood not exclusively as insufficiency and uncertainty, but as transience and temporariness – permeates the ethos dominant, not to say the way of life of “winners”. Karl Marx and Friedrich Engels (2007, p. 47) stated that “[t]he ideas of the ruling class are, in each epoch, the dominant ideas, that is, the class that is the dominant material force of society is, at the same time, , your dominant spiritual force.” The consideration also applies to lifestyle. Subjective precariousness constitutes a norm of neoliberal rationality, which, like everything else, affects different social classes unequally.

Mental health

In 2021, the world watched gymnast Simone Biles give up on continuing in the Olympic competition held in Tokyo. The reason given by the athlete was her mental health. Two aspects of this fact deserve our attention. The first of these is the commonplace given to the expression mental health, either to refer to its absence or to express the need for self-care in relation to it. “Mental health” (or “mental health”, in the world's dominant language) communicates the problem on a global scale.

Derived from the first, the second aspect intertwines the current meaning of the concept of mental health with the social and cultural imaginary of neoliberal societies. The athlete's withdrawal is both a refusal to continue in the competition and the need to manage her own mental health. If, on the one hand, refusal could emerge as resistance to such imagery – French sociologist Alain Ehrenberg (2010) highlighted how high-performance athletics works as a paradigm of contemporary sociability, based on performance, goals, achievements, overcoming[iii] –, on the other hand, self-care for one’s own mental health is yet another incitement of one’s own imagination.

Ultimately, as the neoliberal doctrine states, we are all responsible for our conditions – including health, in general, and mental health, in particular. Nikolas Rose (2013) has already drawn attention to the contemporary trend according to which we have become economists of our own health (failing to safeguard it, consequently, tends to intensify suffering due to the pathological condition). But how, after all, did the concept of mental health become established in our social imagination?

To understand the emergence of the concept of mental health, it is necessary to refer to the history of the other extreme, madness.[iv] Em history of madness, Michel Foucault (2003) presents a historical and empirically documented perspective on the topic. It is not the case to address here the complexity of concepts relating to madness in the medieval, Renaissance and classical periods, according to the periodization explored in the work. It is worth highlighting that mental illness – a symbol of the birth of psychiatry as a science in modernity – comes from the transformation of the classic experience of hospitalization into a medical object.

In this way, the author points out that the medical meaning given to the hospital is a modern invention. In the medieval period, the hospital fulfilled a charitable function, as a shelter – “house for guests”, according to the etymology of the term. In the classical period (2003th and XNUMXth centuries), it became an establishment of control and social and political order. The appropriation of the classic experience of hospitalization introduces the medical meaning consecrated by the term “mental illness”. By proceeding genealogically, Foucault (XNUMX) maintains in his thesis that it is not a question of “discovery” of scientific fact, as the medical hagiography of psychiatry points out when reporting its own history, but of attribution of meaning.[v]

The so-called “liberation of the chained” – carried out by Philippe Pinel – attributes medical meaning to the classic experience of unreason by reintegrating madness into reason, as a state of it. Conceiving mental alienation as a negative part of reason is perceiving it as a state of reason itself, which can then be cured and reintegrated. From Pinel to Hegel this is what happens in medical and philosophical modernity: as a denial of reason, without ceasing to be part of it, madness can be dialectically overcome. In medical terms, mental illness can be cured.

It is the moment when the psychiatric hospital emerges as a healing device in the hands of the alienist doctor. The axiom of Jean-Étienne Dominique Esquirol, the first alienist in fact, is known, if considering the role of encyclopedic doctor played by Pinel (Castel, 1978, p. 98): “A house for the alienated is an instrument of healing; in the hands of a skilled doctor it is the most potent therapeutic agent against mental illnesses” (Esquirol, 1838, p. 398).

Medical power, psychiatric hospital and mental illness therefore form the modern scheme of madness that lasted in the 2003th and 498th centuries. More than knowledge, it is about the exercise of power. “If the character of the doctor can delimit madness, it is not because he knows it, it is because he dominates it” – this is Michel Foucault’s thesis (1978, p. XNUMX). The doctor's right will must impose itself on the patient's disturbed will, just as the hospital operates as a pedagogy of order over the being of disorder (Birman, XNUMX). Despite the purpose of medical cure, today we all know the catastrophic dimension of the asylum model,[vi] which has not yet completely disappeared from our social landscape.[vii]

It is the project to deconstruct the hospital-centric model that will make possible the emergence of the contemporary concept of mental health. But the concept will also contain ambivalence. On the one hand, social advancement (it is its progressive side, critical of the asylum model and in defense of human rights); a counter-revolutionary movement, so to speak, will try to capture the concept by making it converge with the social and cultural imaginary of contemporary capitalism (it is its conservative side, an unintentional effect of criticism, which ends up promoting ideas such as optimization, performance, welfare production).

As for the first sense, the concept of mental health takes shape from the decentralized reactions of different psychiatric reform and rupture movements. These are called “alternative psychiatry”, or, more generally, “anti-psychiatry”. Roughly speaking, these are movements that emerged in the 1960s, in Europe and the United States. Among the most reformist experiences, the English therapeutic community, North American community or preventive psychiatry, institutional psychotherapy and French sector psychiatry stand out.

Willing to radically break with the hospital-centric psychiatric paradigm, English anti-psychiatry and Italian democratic psychiatry stand out. It is not the case to examine here the contributions, particularities and leadership of each of these alternative experiences. For our purposes, it is worth highlighting that, as a challenge to the traditional psychiatric device, such movements contributed to the deinstitutionalization and, albeit in a less effective way, to the deinstitutionalization of mental illness.[viii]

Several studies published in the 1960s – such as those by Thomas Szasz (1979), Ronald Laing (1978), Michel Foucault (2003), Erving Goffman (2007), David Cooper (1973), Franco Basaglia (1985) – also formed a “community of action” (Foucault, 1999b), although not planned as such, against the hegemonic psychiatric device. Despite the subtleties and complexities that such generalizations entail, the social advancement provided by the criticism of the asylum model, based on the psychiatric hospital, comes from this context.[ix]

Almost half a century later, more precisely in 2001, the world health report, from the World Health Organization (WHO), was dedicated to mental health, with the title – quite expressive – Mental health: new conception, new hope. In effect, the document begins by recognizing that the fundamental purpose of mental health, namely the deinstitutionalization of mental illness (the replacement of the hospital-centric model), has not been achieved globally.

According to the document, the aim is to consolidate the paradigm shift triggered, in the second half of the 2001th century, by three factors: the development of psychopharmacology, the institutionalization of human rights and the incorporation of the mental element into the WHO's concept of health ( 20, p. 79 and XNUMX). Replacing the hospital-centric model with mental health care and policies in the community, humanizing and prioritizing treatment in primary care, destigmatizing and preventing mental disorders, equating mental health with physical health and promoting it: these are the fundamental and indispensable objectives propagated by the report.

In fact, its influence will be decisive, as can be seen from the approval, in Brazil, of Law 10.2016 in the same year the report was published (Delgado, 2011). The so-called Psychiatric Reform Law, it is worth noting, had already been in progress in the National Congress for 12 years. It is not our purpose to examine the advances and obstacles surrounding the implementation of such a policy here, but to highlight that the concept of mental health emerges associated with the process of humanization, destigmatization and deinstitutionalization of mental illness. Ultimately, it is about overcoming the nomenclature that crowned the birth of psychiatry, replacing it with its opposite: mental health. Mental disorder or psychological suffering, expressions subsumed under the umbrella “mental health”, will increasingly be referred to as “mental health problems”.[X]

In effect, the concept of mental health becomes increasingly comprehensive. It involves both psychological suffering, which, in turn, ranges from psychosis to anxiety, and well-being. It is worth noting that at this other end of the spectrum (well-being) lies the incorporation of the mental element into the concept of health. Let us remember the famous and controversial definition of health, which has existed since the establishment of the WHO: “health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” (WHO, 1946 , p. 1).

The controversy surrounding the definition is mainly due to the identification of health with well-being (in its fullness), equating it and thus reducing it to happiness. Such scope and indeterminacy may constitute, in our view, one of the fundamental flanks for the neoliberal capture of the term, transmuting its primary social meaning. No longer restricted to the hospital space, psychiatry – a royal science in the interdisciplinary, multidisciplinary and paramedical field of mental health[xi] – becomes authorized to intervene in the open space of society.

More than that, all wellness medicine and supplementary mechanisms (such as nutrition, meditation and psychotherapeutic techniques) will act directly in the production of well-being, modulating and shaping individuals. This is what we call “mental health biopolitics”: the appropriation of the term arising from criticism of the traditional psychiatric model and the attribution of a new meaning. It is true that such a sense is not absolutely new.

In the 1980s, Robert Castel (1987; 2011) drew attention to the emerging “new psychological culture”, whose “therapy for the normal” supplanted the distinction between the normal and the pathological, authorizing medical and technical intervention on the normality of individuals to enhance their relational and professional dimensions. The consolidation of mental health and its semantic transmutation will be fundamental for such a technology of power typical of neoliberal governmentality.[xii]

The ordinary use of the expression, as mentioned previously, makes the latent biopolitical concern explicit. Self-care for mental health, which is often nothing more than the production of more health, is a conduct management policy that dispenses with any external coercion to maximize strength, potential and qualities .

A fundamental aspect analyzed by Michel Foucault (2008b) in his course on German and North American neoliberalism is precisely that such technology of power operates from the rationality of the governed. In a social model divided between “winners” and “losers”, individuals themselves are responsible for success or defeat. This responsibility also includes the management of mental health itself, which thus operates as a form of social control. It is necessary to maintain productive conditions, optimizing them as much as possible.

Mental health is also a matter of social adjustment. In fact, one of the fundamental criteria for diagnosing a mental disorder lies in the impairment of functional capacity. The “health” of a given model of society depends on specific mental health. Little by little, as we can see, the concept of mental health not only gained evidence in everyday social life, but its initial critical meaning was also partly captured and subverted by the socially and culturally dominant imaginary of neoliberalism.

Covid-19 pandemic

In March 2020, the WHO officially declared the Covid-19 pandemic. Faced with the sudden suspension of economic activities, which lasted for months, several analyzes asked whether we were facing a crisis of current capitalism and sociability. The global health crisis, associated with the resulting economic and social crises, as well as the already established climate and environmental crises, has turned society into a true open-air laboratory for sociologists, anthropologists, political scientists, philosophers, among other specialists in the human and social sciences. .

The production and circulation of scientific data between researchers from different areas involved in combating the disease (infectology, virology, epidemiology, biology, physics, mathematics, among others) as well as social, political, economic, cultural, philosophical, geographic and historic events happened at a speed similar to the spread of the virus in a highly globalized world.[xiii] As the rupture and the new tend to be installed following the crisis, the first moment was one of social hope in many of the analyzes carried out in the heat of events, despite the skepticism of a large part of them.

In fact, months later, even without the return to activities in person, it was already possible to see that everything was not only returning to “normal”, but also at an accelerated rate. The very expression “new normal”, which initially could have a transformative connotation, came to mean nothing more than a cosmetic and hygienic change in current sociability, accelerating the course of the “civilizing process”, in the sense analyzed by sociologist Norbert Elias (2001 ; 2011).[xiv]

A relative consensus emerged from the experience. On the one hand, the pandemic operated as a “photographic revealer”, according to the analogy used by Peter Pál Pelbart (2021b, p. 14): “what was under our noses, but we could not see, appeared in the light of day – a not only a health, social, political and environmental catastrophe, but a civilizational one”. Indeed, the pandemic has left society raw. In a way, it showed the absolute complexity, interrelationship and interdependence that constitute human life in modern societies, highlighting Émile Durkheim's thesis (2010, p. 36) according to which individuals are “functionaries of society ”.[xv]

No essential work could be done without. Hence, probably, the social hope around a society effectively based on solidarity, which, in the Durkheimian sense, does not consist of generosity, but of cooperation and collective responsibilities. The opposite, therefore, of individualism and exclusively individual responsibilities intrinsic to the neoliberal imaginary. But the pandemic also showed, in a sensitive way, social wounds. The initial belief that the virus would be “democratic”, in the manner of the myth of racial democracy, soon fell apart.

It was the most vulnerable who were most susceptible to the catastrophe, as the first death caused by the virus in Brazil – of a domestic worker – already signaled from the beginning, highlighting, once again, how every “natural” disaster devastates and further degrades people. popular classes[xvi]. Data proved how poor, black, indigenous and quilombola populations were more vulnerable to the contagion and lethality of the virus. Also on a global scale, inequality was exposed.[xvii] The savage appropriation of masks, tests, respirators and vaccines by rich countries compromised the humanitarian rhetoric of leaders who extolled the war against the virus, while at the same time contradicting the basic premise that a pandemic is, by definition, global.[xviii]

On the other hand, the finding that the Covid-19 pandemic acted as a trend accelerator also became relatively consensual. Distance learning, remote work, digital, communicative and mental overacceleration, availability for work without the right to disconnect, precariousness, platformization, structural violence (racial, gender, harassment in the workplace). If, on the one hand, the pandemic constituted the condition of historical possibility for what was in a state of latency (remote work, teaching and medical care, for example), on the other, it accelerated what was already underway .

It was no different with “mental health”, taking the paradox of expression to the extreme when it refers to the absence of what it says.[xx] Mental health problems, according to current terminology, have become even more on the agenda. In effect, we have seen an exponential increase in the incidence of depression, anxiety and post-traumatic stress, both among those infected by the virus[xx] as well as due to social isolation, unemployment, private losses of grief, widespread insecurity, the increase in alcoholism, overwork of those who were on the so-called “front line” of combating the disease, but also of “uberized” ” and the “cognitariat” or “cognitive workers” subjected to the total work regime of cognitive and immaterial capitalism (Lazzarato & Negri 2001).[xxx]

In a word, the pandemic took the “Jagrená car” metaphor, used by Anthony Giddens (1991) to the extreme, to highlight the lack of control and predictability in the modern world, despite the rationalization project that underlies it. Psychologically, the effect of revealing lack of control was a significant increase in psychological suffering (or “mental health problems”).

Let's look at the data. According to the Scientific Brief published by the WHO in March 2022, the Covid-19 pandemic triggered a 25% increase in the prevalence of anxiety and depression in the world (Opas, 2022a). The most affected are young people and women. In the case of young people, this is probably due to the closure of schools, the restriction of social interaction, the fear of unemployment and the insecurities that already characterize and plague this phase of life. In the case of women, due to the intensification of domestic violence and the overload of domestic and care work, as well as structural gender inequalities, added to the common concerns of humanity in relation to the virus, despite the different living conditions for protect yourself from risks.[xxiii]

A study by the Faculty of Medicine at the University of Queensland, in Australia, also showed a 28% increase in depression (53,2 million new cases) and a 26% increase in anxiety (76,2 million new cases) as a result of the pandemic ( Santomauro et al., 2021). Based on reports from 204 countries and considering the period from January 2020 to January 2021, the study also highlights the higher incidence of disorders in young people and women.

In Brazil, specifically, a joint survey carried out by the global public health organization Vital Strategies and the Federal University of Pelotas (UFPel), in the first quarter of 2022, showed that there was a 41% increase in cases of depression in the country (Vital Strategies & UFPel, 2022). Among women, the increase was 39,3%. Postpartum depression also grew by 20% during the pandemic, according to a study by the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (Galetta et al., 2022).

In March 2020 – therefore, at the beginning of the pandemic – pulmonologist Victor Tseng, from Emory University Hospital, in Atlanta, United States, released a graph showing the impacts of Covid-19 on health systems. The fourth wave, marked by a continuous rise over the course of the pandemic, would consist, according to predictions, of psychological trauma, mental illnesses, burnout and economic losses.[xxiii] Such data and information reveal the intensification of what was already underway. In 2017 – therefore, before the pandemic –, the WHO had announced the increase, between 2005 and 2015, of 18,4% of cases of depression and 14,9% of anxiety disorders in the world.

However, the pandemic did not only result in an increase in the incidence of mental disorders. By further highlighting the importance of the problem, the pandemic exposed the historic underinvestment, on a global scale, in mental health services according to Dévora Kestel (Opas, 2022a), director of the Department of Mental Health and Substance Use at WHO.[xxv]

It is true that a significant proportion of mental health problems fall on the most vulnerable and underserved populations.[xxiv] However, mental health problems are also the reverse of neoliberal subjectivation, that is, of the mode of production of existence, subjectivity and lifestyle in contemporary, predominantly neoliberal, capitalist culture. Pierre Dardot and Christian Laval (2016, p. 357) conceptualized this way of leading and governing life as “ultrasubjectivation”. If the vital principle of neoliberalism is unlimited competition, ultimately competition is not just with others, but with oneself.[xxv]

It is an ethics – in the Weberian sense of life conduct (Weber, 2004) – of performance produced by neoliberal culture and incorporated by individuals as if it were natural. O ethos of the high-performance athlete has become the norm: achieving, meeting and exceeding goals. But the principle of unlimited self-overcoming implies, paradoxically, self-suppression. In fact, Alain Ehrenberg (1996) has already shown how success and failure constitute two faces of the same self-government of the neoliberal imaginary, characterized by the author based on supposed autonomy as a social norm.

The explosion in cases of depression, according to the French sociologist's study on the subject, comes from individual exhaustion and the way of naming psychological suffering in this new form of social organization according to which individuals must make, under their sole responsibility, the best choices (Ehrenberg, 1998). In fact, according to the logic of human capital, in each individual choice lies an investment with different potential income and future returns, just like a “portfolio” or “portfolio” of financial investments. Failure is also individual, according to the reasoning widely spread and incorporated into contemporary capitalist culture.

The neoliberal “ultrasubjectivation” that governs individuals without evident external coercion (therefore, based on a supposed freedom) produces the “neosubject” with their clinical diagnoses (Dardot & Laval, 2016, p. 361-372). This means that we are no longer in the field of Freudian neurosis, possible from the disciplinary paradigm of interdiction. In the post-disciplinary social model in which unlimited competition prevails and in which individuals conceive of themselves as a company, the types of psychological suffering are mainly depression (expression of failure), anxiety (manifestation of anguish arising from the always imminent risk ) and the syndrome of burnout (completion of work exhaustion).[xxviii]

Not surprisingly, a new word emerged when returning to “normal” activities after the advancement of vaccination and the containment of the lethality of the SARS-CoV-2 virus. “Re-entry anxiety” began to designate not only the anxiety due to the return that requires biosafety protocols in the pandemic context, but also the anguish of having to face activities considered normal again (Reynolds, 2021). In her genealogy of neoliberalism based on the clash between Walter Lippmann and John Dewey – considering the way in which they resort to Darwinian evolutionism –, Barbara Stiegler (2019; Corbanezi, 2021b) explains how the fundamental question for neoliberalism, since its elaboration, consists in making the individual adapt to the increasingly elastic demands of this societal model.

The mantra of flexibility emerges, in this sense, as a strategy to adapt. However, the increasing number of psychological suffering – intensified in the pandemic context – may show natural human resistance to a similar adaptation process, despite the psychopharmacological production available to normalize and optimize individual behaviors and capabilities.

Precariousness

It is known that the pandemic has also intensified the processes of making life precarious. It can be said that precariousness is practically a modern institution,[xxviii] which is why there was nothing new in the pandemic context, other than the acceleration of the “normal” course of capitalist societies. Precariousness has been present since the establishment of modern industrialism, with the exploitation of child and female labor in long hours of alienated work without rights in factories. Capitalist society and exploitation cannot take place without precariousness. This is what happened in the different historical stages of modern capitalism (liberalism, Taylorism-Fordism, welfare state, neoliberalism), despite their differences in degree.

In neoliberal societies, the process of precariousness is taken to the extreme with the systematic removal of social protection networks and deregulation in favor of the market and capital, further disadvantaging – both objectively and subjectively – the popular and working classes. This is not exactly a “reduction” of the State, as the expression “minimum State” might imply. A strong State is part of the neoliberal doctrine from the formulation of German ordoliberalism to the legacy of Walter Lippmann, Friedrich Hayek and Milton Friedman in North American neoliberalism (Foucault, 2008b; Dardot & Laval, 2016).

The fundamental question is which side the State is on: whether it acts – as Pierre Bourdieu (1998, 2008a) puts it – with the “right hand”, that is, in favor of economic policies that favor the dominant classes, or with the “ left hand”, in terms of developing social policies. In neoliberalism, in its varied existing empirical forms, what Loïc Wacquant (2012, p. 512) designated as a “Centaur-State” predominates, with distinct faces representing duality in relation to the extremes of social stratification: uplifting and liberating at the top and penalizing and restrictive on the basis.

According to this logic, in the neoliberal form prevalent in Western capitalist societies there is an institutionalized “base precariousness”. Withdrawal of social rights, platformization, uberization, work deregulation, informality, subcontracting, salary degradation, dismantling of essential public services such as health and education. All these procedures, which mainly harm the popular and disadvantaged classes, constitute the precariousness of the base of the social pyramid. Its dimension is objective and socially structured.

Pierre Bourdieu (1998) highlighted, in the 1990s, that precariousness in neoliberal societies is not an economic fatality, but a political strategy: as such, at the same time as it establishes a generalized war through the competition of all against all, it demobilizes collectivities such as associations , unions and solidarity between individuals.[xxix]

However, precariousness is not located strictly at the base of the social pyramid. To be effective, it also needs to circulate as a value from the dominant classes, constituting itself as a social norm. It is worth noting that the economic theory of human capital also needed to be converted into a social value in order to guide the conduct of individuals, as can be seen, for example, in the radical transformation of the conception of consumption as a form of investment today (López- Ruiz, 2007).

Despite the differences, it can be said that precariousness is, in a certain way, the modus operandi (at least ideologically) of the way of life of individuals who make up the dominant classes. In terms of institutionalization and social and cultural norms, the process can resemble both the constitution of the self-image of superiority of Western civilization, as analyzed by Norbert Elias (2011), and the establishment of “legitimate” culture, according to the sociology of culture by Pierre Bourdieu (2007).

In both cases, what becomes a social value considered legitimate and superior, with implications in terms of relationships and the exercise of power, comes from the nations, peoples and dominant classes. Ultimately, we could say, not without controversy, that such sociological demonstrations are variations of the reasoning according to which the dominant ideas of an era are the ideas of the dominant classes (and peoples) (Marx & Engels, 2007).[xxx]

In this sense, according to Laval's formulation (2017, p. 101), it is possible to affirm that there is a “culture of precariousness” and even a “precariousness of luxury”. It is evident that the dimension and effects of precarity are absolutely different between social classes, ranging from distinction to social, economic and cultural violence. But it is important to note that it also comes from the predominant way of life, widespread among high-performance businesspeople and executives, who promote uncertainty, risk, mobility, speed, flexibility and deterritoriality, such as the attributes of financial capital.

The famous metaphor of “liquidity” elaborated by Zygmunt Bauman (2001) precisely expresses the transformation of modern stability (in the name of social order) into the institutionalization of contemporary instability (in the name of supposed individual freedom). In these terms, the production of instability – an intrinsic characteristic of precariousness – is not restricted to the dominated, despite the growing precariousness of the working class promoted by the dominant classes. In a society divided between “winners” and “losers”, like sports competitions, it is those who take risks and uncertainties who can reach the social podium, according to the literature. management.

In other words, it is the “riskophiles” (“courageous dominant”) who are the potential victors, as opposed to the “riskophobes” (“fearful dominated”), who only have responsibility for their condition as failures, according to neoliberal precepts ( Laval, 2017, p. 104). The “flexible capitalism” analyzed by Richard Sennett (2019) does not only reside in the productive and labor flexibilization typical of the current productive paradigm. Being flexible – consequently, more adaptable – is the norm for a way of life whose example comes from above. The “strength of character” of the capitalist today – says Sennett – is that of “someone who has the confidence to stand in the disorder, someone who thrives in the midst of dislocation. […] True winners do not suffer from fragmentation” (Sennett, 2019, p. 72).

In a broad sense, precariousness means not only insufficiency and scarcity, but also uncertainty, provisionality, instability, transience. If the latter meanings intensify the former when experienced by the popular classes, it is the same latter meanings that attest to the true pedigree of “riskophiles”. Speed ​​for multiple movements (geographic, digital, inter-organizational, professional), versatility, resilience, flexibility, autonomy and optimism. According to socially diffuse managerialist precepts, all these characteristics constitute the true differences that make success possible in the current phase of capitalism, when combined with intelligence, creativity, communicative capacity, social capital.

Little by little, precariousness, in this expanded sense, can then constitute itself as a culture, norm and even social distinction. For the ethos dominant business and executive, stability has become synonymous with accommodation, laziness, failure. It is no surprise that stability in public service has been one of the privileged targets of neoliberal discourse since the 1990s. In the “liquid modernity” analyzed by Bauman (2001) – in which social ties themselves are provisional and disposable, at the whim of convenience –, the transience between different jobs and the flexibility in them constitute a fundamental disposition for success.

An example of the promotion of such an idea lies in the concept of “careers without borders”, according to which permanent investments in employability and mobility between careers are vital for a minority of highly qualified workers who occupy the top of the social hierarchy (Souza, Lemos & Silva, 2020). It is clear how precariousness concerns the ethos dominant, although its social extension and concrete form unequally involve classes and social groups. As much as ideas, the dominant lifestyle tends to be the lifestyle of the dominant, who are deterritorialized, fast-moving individuals, promoters of risk and uncertainty – in Bauman’s terms (2001, p. 22), the “absent masters ”, whose prototype is Bill Gates.[xxxii]

When diagnosing the transition from disciplinary historical-social formation to the post-disciplinary control regime, in which the business imperative of mobility, speed and permanent training operate in the open, Gilles Deleuze (1992, p. 226) stated: “ The rings of a snake are even more complicated than the holes of a mole.” Despite the author's consideration that each regime has its own subjections and liberations, this is a way of saying that modulation (adaptation, flexibility, instability) proves to be more pernicious than disciplinary institutional molding.

But neoliberal rationality – based on the principles of limitlessness, competitiveness, transience, mobility, speed and deterritoriality – not only “intensifies” objective precarity but also causes subjective precarity as a standard. According to sociologist Danièle Linhart (2009), even among stable employees, the managerial logic of contemporary capitalist societies raises widespread subjective precariousness based on the demand for excessive productivity, competition between peers and institutions and the consequent individualization and social isolation.[xxxi]

The effect of this dominant way of life, based on subjective self-exploitation, risk and excess typical of the so-called “performance society” (Han, 2017), is the production of exhaustion, psychological suffering and mental disorders (syndrome burnout, depression, anxiety, insomnia), although – it is always worth insisting – the incidence, form and degrees of precariousness are profoundly different between social classes and their different occupations.[xxxii]

The Covid-19 pandemic has also intensified subjective precariousness. After a brief suspension of activities, everything returned even more quickly, albeit in “distance” mode. However, it is not inappropriate to note that, during the pandemic crisis, the economic elites who tout flexibility and ultra-fast nomadism have accommodated themselves in the comfort of their homes in the sedentary lifestyle of solid modernity, unlike workers on the various “front lines”. ”, whose objective and subjective precariousness once again degrades its structural and structuring conditions, in terms of Pierre Bourdieu’s (1983) genetic structuralism.

In this sense, as anthropologist João Biehl (2021, p. 243) certifies, the pandemic must be considered an “aggravated chronic” event, as it exposed structural vulnerabilities and modes of functioning of the hegemonic societal model. The pandemic thus constitutes a sociological event of paramount importance.

Conclusion

When examining contemporary processes of neoliberal subjectivation, we analyze both in isolation and in relation to the concepts-events “mental health”, “Covid-19 pandemic” and “precariousness”. As subjection and mode of production of existence, the ongoing processes of subjectivation tend to produce a dominant and common form of subjectivity, despite the incitement to individual difference typical of the neoliberal imaginary. Despite the principle of optimizing mental health, according to the semantic transmutation of this concept based on its neoliberal appropriation, contemporary Western capitalist societies not only reinforce objective precariousness – particularly in peripheral societies, such as Brazil – but also provoke precariousness subjective.

Such processes were significantly intensified during the pandemic period, accentuating the contradiction according to which a society that constantly encourages the performance and promotion of mental health paradoxically produces fatigue and psychological suffering (Han, 2017), just like chronic unhappiness as an effect of a society that conceives life exclusively as the search for happiness (Sahlins, 2004, p. 23).

Together, the terms “mental health”, “pandemic” and “precariousness” point to a subjectivation characterized by exhaustion, a relationship with subjectivity similar to the way in which extractive and predatory capitalism relates to nature and the environment. In other words, in the context of post-pandemic neoliberal rationality, we also witness the exhaustion of psychic ecology, which can configure our contemporary times as a time of total exhaustion, when considered together the industrial relationship of the human being with nature and with oneself .

On the one hand, such a statement can encourage the need to invent and promote new forms of subjectivity, refusing (and resisting) the one that has been silently imposed on us (Foucault, 1994, p. 239). On the other hand, since we are not a society against the State – like the indigenous peoples studied by Pierre Clastres (2013) –, a state organization that is in favor of society is necessary, contrary to the famous Thatcherite neoliberal motto according to which “there is no society, only individuals".

The way out of the crisis of total exhaustion arising from neoliberal rationality and intensified in the pandemic context requires the invention of other forms of non-destructive sociability, such as that based on the principles of individualism, precariousness and unlimited competition.

*Elton Corbanezi is a professor at the Department of Sociology and Political Science at the Federal University of Mato Grosso (UFMT). author of Mental health, depression and capitalism (Unesp).

Originally published in Magazine Society and State (UnB), vol. 38, no. 2, 2023.

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Notes


[I] This logic is similar to the appropriation by contemporary post-disciplinary capitalism of the elements that supported both the criticism of Taylorist work and artistic production (namely: creativity, invention, affections, mobility, flexibility), as shown by Luc Boltanski and Ève Chiapello (2011). In force in the current productive paradigm, which values ​​subjectivity, such characteristics were opposed to the mechanical repetition present in work in its disciplinary form (Lazzarato & Negri, 2001).

[ii]Regarding the conceptual expression “neoliberal rationality”, see, especially, Pierre Dardot and Christian Laval (2016), whose work follows the path inaugurated by Michel Foucault (2008b) in his analysis of the political rationality of neoliberalism. See also Elton Corbanezi and José Miguel Rasia (2020).

[iii] Christian Laval (2020, p. 280-281) also highlights how competitive sport is “the metaphor of human limitlessness at the heart of the neoliberal imagination”.

[iv] The following exposition, in this section of the article, is based especially on Corbanezi (2021a).

[v] In effect, Friedrich Nietzsche's (1998) genealogical procedure consists of highlighting the appropriation and attribution of meaning to knowledge, values, language and institutional purposes. When questioned, Foucault himself (1994, v. 4, p. 731) recognizes that his History of Madness could be understood as a “'new genealogy of morals' […] without the solemnity of the title and the grandeur that Nietzsche imposed on it” ..

[vi] In this regard, see, for example, the book-report by Daniela Arbex (2013).

[vii] On the topic, see the report by the Federal Council of Psychology (2020). Carried out in December 2018, the national inspection examined 40 psychiatric hospitals in Brazil, located in 17 states across the five national regions. According to the report (CFP, 2020, p. 17), the sample corresponds to around a third of the total number of psychiatric hospitals with public beds in operation in the country. The report ends with recommendations for effective deinstitutionalization, as established by Law 10.2016/2001 (Psychiatric Reform Law), since “the inspected establishments meet several requirements that characterize them as asylums, violators of human rights and, in many of the reported cases, perpetrators of inhumane, degrading and ill-treatment practices” (CFP, 2020, p. 506).

[viii] Deinstitutionalization is a more radical process of rupture, which does not just mean deinstitutionalization, but the dismantling of the psychiatric device that institutionalized mental illness and the implementation of a solid network of community alternatives. In this sense, the experience of Italian democratic psychiatry stands out, with the establishment of Law 180, also known as “Basaglia Law”, in 1978 (WHO, 2001, p. 80-81 and 122). On the concept of deinstitutionalization, see Denise Dias Barros (1990).

[ix] Etymologically, the word “asylum” consists of the conjunction of the Greek term manía (madness, dementia) and the Greek verb koméó (to take care, care) (Houaiss & Villar, 2009).

[X] In the Report (WHO, 2001), the term “mental illness” appears in a diminutive form, while the expressions “mental health problem” and “mental disorder” are abundant. Likewise, the presentation of the publication of the 11th edition of the WHO's International Classification of Diseases (ICD-11) uses the expression “mental health conditions” to refer to mental disorders (Opas, 2022). It is important to note that the term “mental disorder” has been used since the first edition of the DSM (American Psychiatric Association, 1952) due to the lack of pathophysiological knowledge regarding mental illnesses. Its definition appears with subtle variations since DSM III (American Psychiatric Association, 1980). In accordance with the DSM, the International Classification of Diseases (ICD), from the WHO (1993) and PAHO (2022a), also uses the term “disorder” for mental pathologies, while for other pathological species , effectively uses the concepts of “disease” or “illness”.

[xi] In addition to psychiatrists, the field of mental health is made up of nurses, psychologists, social workers, educators and occupational therapists, among others.

[xii] Regarding neoliberal governmentality in relation to the “new psychological culture” post-psychoanalysis, which circumscribes the so-called “therapy for the normal”, see Castel’s “Preface” (2011) to the reissue of his book, 30 years after its release.

[xiii] In this regard, see, for example, the Critical Pandemic initiative, by Editora N-1, which, for approximately five months, published on its website one text per day by intellectuals, artists, indigenous leaders, among other analysts and activists from all over the world. the world (Pelbart & Fernandes, 2021; 2021a). The texts are also available at: . Accessed on: 1 Aug. 21.

[xiv] According to Elias (2011), disgust, shame and guilt constitute three important vectors in the psychogenesis of the long Western civilizing process. Everything indicates that the so-called “new normal” has become an acceleration in the hygienic course of the civilizing process as analyzed by the German sociologist, considering the relative maintenance of biosafety protocols (masks, alcohol gel, avoidance of human contact) after containment of the pandemic. According to Elias (2001), we could also say that the pandemic has taken the loneliness to which the dying are condemned to an extreme, considering the necessary isolation within the home itself, in the hospital and in the funeral ritual, surrounded by brutal asepsis in the context of the health crisis. Regarding our problematization about “the new normal”, see Corbanezi (2022).

[xv] By using Kantian terminology, Durkheim thus presents the “categorical imperative of moral conscience”, which would be taking shape in modern societies: “Put yourself in a position to fulfill a specific role fruitfully” (Durkheim, 2010, p. 6, emphasis in original).

[xvi] About the first death caused by Covid-19 in the country, see Cláudia Collucci (2022). We spell “natural” in quotation marks considering that catastrophes classified as “natural” are, to a large extent, unintended (and therefore unforeseen) consequences of the scientific and technological development of industrial societies (Beck, 2011).

[xvii] According to an analysis by Mike Davis (2020), in the midst of the crisis, the new coronavirus pandemic – exacerbated by fiscal austerity – increased inequality between and within countries, imposing an increase in misery on the working class and more vulnerable groups and repeating, thus, the history of other global crises in/of capitalism, such as the Spanish flu pandemic in 1918 and the economic crises of 1929 and 2008.

[xviii] For an alternative understanding to the war paradigm of the virus's conception, see Ferreira (2020).

[xx] The expression “mental health symptoms” (Barbosa et al, 2021) to refer to symptoms of anxiety, depression and stress, for example, explains the paradox in question.

[xx] We refer to the post-Covid-19 condition, also called long Covid and neurocovid (neurological and psychiatric symptoms resulting from Covid-19). The post-Covid-19 condition received an official clinical definition by the WHO in October 2021 (UN, 2021). About the post-Covid condition, see . Accessed on: 19 Aug. 19.

[xxx] The category of “cognitive workers” involves different segments, such as office workers in large companies, teachers, researchers, among other professionals who engage in their activities cognitive abilities such as intelligence and creativity. For this reason, according to Franco “Bifo” Berardi, the category is not reducible to a social class. According to the Italian thinker and political activist, what could unite them in a “process of self-reflection, rebellion and union of cognitive subjectivity is psychological suffering, ethical and existential malaise” (Berardi, 2019, sp).

[xxiii] As warned by indigenous leader Ailton Krenak (2020, p. 6), right at the beginning of the pandemic, the virus was not a threat to planet Earth, but only to humanity, which is why the virus called into question the anthropocentric perspective of humanity. western civilization.

[xxiii] The original graphic can be seen at the following link: . Accessed on: 1244671755 Aug. 781898241. Based on the concept of syndemic (synergistic interaction between two or more diseases, in which the effects reciprocally enhance each other), a similar global projection can be seen in José Patrício Bispo Júnior and Djanilson Barbosa dos Santos (25, p. 2022). It is worth noting, however, that a study by UFG in partnership with Unifesp, Ufes and the University of Zurich (Switzerland), published in June 2021, showed that, in Brazil, levels of anxiety and depression were lower in the fourth wave of Covid- 8 (January 2022) than in the first (June 19). The main reason is that, in the fourth wave, research participants were less isolated and more physically active than in the first. However, despite the reduction, levels of depression and anxiety remain high, the authors emphasize.

[xxv] Regarding the lack of mental health services in Brazil, see the series of reports from Folha de S. Paulo entitled “Brasil no Divã”, especially the article by Júlia Barbon and Adrian Vizoni (2022).

[xxiv] In this regard, see, for example, the study on the serious impacts of violence on the mental health of residents of Maré, a favela complex in Rio de Janeiro (Redes da Maré & Peoples Palace Projects, 2021). The research was carried out in partnership with the School of Social Service and the Institute of Psychiatry at the Federal University of Rio de Janeiro (UFRJ), as well as the Center for Studies in Economics of Culture at the Federal University of Rio Grande do Sul (UFRGS).

[xxv] This is how the authors characterize “ultrasubjectivation”: “Ultimately, ‘accounting’ subjectivation and ‘financial’ subjectivation define a subjectification due to the excess of oneself in oneself, or even by indefinite self-improvement. […] In a way, it is a 'ultrassubjectivation', whose objective is not an ultimate and stable state of 'self-possession', but a beyond yourself always repelled […].” (Dardot & Laval, 2016, p. 356-357, emphasis in original).

[xxviii] Regarding fatigue as an effect of the performance society, see Byung-Chul Han (2017) and Corbanezi (2018).

[xxviii]  We think, here, of the way Giddens understands the concept of “institution” in his theory of structuration, namely: as routinized social practices recognized by the members of a collective (Giddens, 2009, p. 20; Cohen, 1999, p. 426 -427).

[xxix] It is not our purpose here to deepen the study of the topic of precariousness in the contemporary world of work, as addressed in a broad and notable way by the sociology of work. Therefore, we limit ourselves to indicating some relevant references on the issue. Internationally, Robert Castel (2010) and Guy Standing (2014) can be highlighted; nationally, the studies by Ricardo Antunes, Ruy Braga, Tânia Franco, Graça Druck, Cinara Rosenfield, among others, stand out.

[xxx] It is known that both Elias (2000) and Bourdieu (1989) criticize the supposed economic reductionism from which the historical materialism of Marx and Engels would conceive inequality and social conflict. Ideas, however, are in the symbolic field, through which, according to contemporary sociologists themselves, power relations also occur.

[xxxii] Richard Sennett (2019, p. 71-72) exemplifies the clash between the Fordist and flexible-cognitive paradigms through the figures of Rockefeller and Bill Gates, respectively, which constitute the models of solid modernity and liquid modernity, in Bauman's terms (2001).

[xxxi] Regarding this reality in politics and academic life, see our brief essay on academic productivism and mental health (Corbanezi, 2021c).

[xxxii] Regarding the mental exhaustion resulting from new work relationships and precariousness, see Tânia Franco, Graça Druck & Edith Seligmann-Silva (2010).


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