Healing Mental Illness

By Jonathan Durnford / Winter 2020

I jolted awake on a concrete floor, heart beating rapidly to keep time with the pounding in my head, which was in no way helped by the glare of white lights overhead. My knuckles felt raw, my forehead dripped with warm blood. I had no idea how I got there, what transpired between the revels of my 24th birthday and the nauseating chamber imprisoning me. Leaning against the wall, confused and hungover, I reflected on the preceding years. While attending Portland Community College in 2012, I began drinking, using life-long clinical depression and social anxiety as excuses. Upon receiving my associate degree, nihilism took hold, and I gave up on furthering my education. As hope slipped away, I found myself laboring only to survive and drinking daily to forget I lacked purpose. My financial security dwindled, friends left as I took out my frustrations on them, and twice I wound up in emergency rooms due to intoxication. But sitting there locked behind steel bars, surrounded by miserable drunkards I would have happily called companions just to mitigate my loneliness, I was finally convinced that individual effort could not free me from my vice. I checked myself into a ninety-day rehabilitation program, committed myself to recovery, and focused on revitalizing my life. Having access to student health insurance has enabled me to afford medication, a psychiatrist, and a therapist. However, as I experienced for years, getting help for mental health seems unattainable to many Americans. Social stigma often blames mental health issues on the individual, leading many to believe it is up to them as an individual to fix themselves.

My story leading up to rehab goes back much further than the beginning of my drinking habits. By all measures, my father had achieved the American Dream: a profitable job that put him and his small family comfortably in the middle class. That all changed when my father lost his affluent job as a computer programmer due to corporate buyout. He quickly found that “the belief...that if we work hard, obey the law and get a good education we can achieve stable employment, social status and mobility along with financial security becomes a lie” (Hedges). Unable to find work in his trained field due to his age, our financial situation dropped from comfortably middle class to living month to month. I remember him sighing as he tried to prepare my sister and I for the harsh realities of having to move in with our grandma, of eating the same cheap processed food most meals, of having to push through sickness because medicine just was not in the budget. We had become part of what Chomsky refers to as the precariat. Shoved suddenly out of the working class, we lived precariously at the edge of society, financially insecure over necessities like housing, food, and medical care.

Under neoliberalism, “each individual is held responsible and accountable for his or her own actions and well-being” (Harvey). Financial failure is the fault of the individual. A society dominated by this ideology leads to a massive feeling of failure amongst the lower class. That feeling of failure becomes internalized, such that individuals like my Dad now believed that it was his own fault that he was no longer able to provide for his family. That belief trickled down to my sister and I. Even though we witnessed our father lose the game of capitalism, the lesson proclaimed by neoliberalism was to work harder and set ourselves up better financially. Yet when I became financially independent, I found it difficult to achieve a measure of financial success. The internalized belief that my struggles to afford food, rent, and other necessities were due to a personal lack of effort drove me to work overtime weekly. Putting my body and mind through so much stress led me to weed and alcohol to relax, and caffeine to energize. Eventually it became easier to self-medicate than to self-care. I slipped into depression-fueled alcoholism and watched my savings account drain until I had nothing left, everything sacrificed to the altar of addiction and its effects. And it was all my fault. The thought weighed on me with each broken friendship and each unpaid bill until there was nothing left of my identity but my failures.

Talking about my mental illness is difficult. It is scary to be vulnerable, to put my inner thoughts out into the world and face the criticism of whoever is listening. I fear being judged as inadequate or incapable of handling myself financially, mentally, and physically. I fear losing friends because I’m too much for them to handle and being ostracized as different. These are common feelings among those struggling with mental illness, leading to many who need help isolating themselves. Studies have found the majority of those struggling with depression believe they should be able to handle it themselves (Greenfield), and that belief leads to many avoiding seeking help (Davis).

Where did this belief come from? To answer that question, we need to look at the construction of the society that stigmatizes mental health. Hegemony is “when the majority of people in a society accept the social hierarchies as natural and the dominant ideologies as truth” (Twohig). In America, the dominant ideologies that influence mental health stigma are individualism and neoliberalism. Individualism promotes the effort and benefit of the individual, treating others as a competitive threat. Furthermore, neoliberalism promotes profit over people. Under neoliberal ideologies, collectivism is seen as a threat to “freedom, individualism, and opportunity” (Monbiot). As such, true social bonds are discouraged, leaving people feeling alone even when surrounded by peers, who are seen more as competitors. To have a mental illness puts one at a disadvantage and encourages the individualist to keep their struggle secret. Relying on others for help is seen as weakness, because individuals should be able to handle their own life. Individualism discourages dependency upon others, reducing emotional bonding between people. “The shattering of these (social) bonds plunges individuals into deep psychological distress that leads ultimately to acts of self-annihilation.” (Hedges) Isolated, alone, and feeling the stigma of a society that focuses on profitability, those with mental health issues internalize these systemic problems as their own failures.

However, this hegemonic reaction to one’s mental illness is by design. Alan Greenspan, one of the world’s leading economists, testified that much of the nation’s economic success was based on working class insecurity. “If working people are insecure, if they’re part of the precariat, living precarious existences, they’re not going to make demands, they’re not going to try to get better wages, they won’t get improved benefits” (Chomsky). By intentionally implementing policies and practices that undercut the average citizen’s ability to financially support themselves, corporations can continue to increase profit without worrying that the workers will mobilize against them. Workers constantly go to work when sick because we can neither afford to take the time off nor afford a visit to the doctor. I missed my grandmother’s funeral because I would have lost my job if I flew home for the weekend, and my financial situation was too tenuous to risk being unemployed. The corporations that employ workers do not give them adequate means to take care of themselves or their social relationships, then lay the blame squarely on those very same workers when their minds break.

Further adding to worker insecurity is the high cost of mental health solutions. Australian historian Humphrey McQueen notes that neoliberalism ideology pushes the private market to commodify every aspect of our lives. Under neoliberalism, access to healthcare becomes profitable. Mental health treatment is an ongoing and often lengthy process. Because of this, many insurers limit coverage for mental illness indirectly proportional to other medical services. Patients may have limited outpatient visits and inpatient stays allowed per year, and often with a higher copay (Davis). Much of mental health treatment is also based on prescription drugs. The dominant biomedical model of mental illness states that they are due to neurochemical imbalances and other biologically originated causes. Under the biomedical model of mental health, the solution to chemical imbalance is to use drugs to reestablish the balance. Johann Hari notes that this biomedical model was pushed more by pharmaceutical PR departments than by scientists. Pharmaceutical companies then profit from the very model they pushed, despite evidence that biological factors may not be the underlying cause. For example, depression is often blamed on low serotonin levels, and a whole class of expensive and unreliable treatment in the form of Selective Serotonin Reuptake Inhibitors (SSRIs) has evolved out of this idea. However, studies have shown that this notion is demonstrably false (Hari). The underlying cause behind most mental illness is neither biological nor individual, but rather social.

Leading social scientists present overwhelming evidence that depression and anxiety are largely responses to social forces, not biological forces (Hari). Human beings are social animals. We need each other to survive. Individualism atomizes us from each other, promoting the need for each person to be fully self-sufficient. But this is contrary to Maslow's hierarchy of needs, a popularly accepted model describing human motivation and needs (McLeod). Lower level physiological needs must be met before higher level social needs can be attended to. Disrupting the precariat’s ability to provide for their physiological needs further detracts from an individual’s ability to create loving connections and feel that sense of belonging that is inherent in all of us. Furthermore, belonging is listed as a baser level of needs than the self-actualization and self-esteem promoted by individualism. Usurping the natural importance of social connection in favor of individualism undermines our ability to achieve self-actualization because we have been trained not to attend to our social needs. We forgo helping others in lieu of focusing on ourselves. When we are disconnected from each other through competition and self- imposed isolation, we are left in a state of anomie.

Anomie, a term created French sociologist Émile Durkheim, refers to the psychological distress that comes from the shattering of social bonds as promoted by neoliberalism and individualism (Hedges). We become critically lonely people who are driven into the arms of consumerism and social media for comfort. We use possessions or number of followers rather than personality traits to display our social standing. We begin to believe life is about accumulating wealth and followers rather than building meaningful connections. What little excess funds we may have gets invested back into the stuff that becomes synonymous with our identity. As distressed as we are, we are encouraged to mask it, as the strong individual doesn’t need to rely on others for help. Anomie becomes a repetitive cycle that drives us further and further into isolation and despair. “The self-destructive pathologies that plague the United States—opioid addiction, morbid obesity, gambling, suicide, sexual sadism, hate groups and mass shootings—rise out of this anomie” (Hedges). Without strong social bonds, we turn to a form of self-medication to take care of us. In my case, it was alcohol. It was easier to not think and to not feel in a society that discourages real relationships and real conversation. Then alcohol became part of my identity. Self-medication evolved into self-identity. The connections that I built were from coworkers in the industry, regulars at my bar and other bars that I frequented, and guests at house parties. If I wanted to engage in social interaction, it was often at the behest of a bottle.

How did this noumenon of self-medication become so prevalent in our society? We are social creatures who need connection in order to thrive. Deprived of these connections we face the overwhelming psychological pain of anomie. Studies have found that we process social and physical pain with the same neural circuits, which explains why opioids work for both physical pain as well as mental (Monbiot). But which is worse? Maslow’s hierarchy of needs would suggest that physical pain is worse than emotional pain, as physiological needs make up a lower level of the hierarchy. However, the opposite has been shown. One study found that children facing emotional neglect suffer worse mental effects than those who suffer physical harm (Monbiot). In this light, self-harm begins to make sense. If physical harm is preferable to emotional harm, then distracting those neural circuits with physical pain partially mitigates the emotional pain. Hangovers are the most recognizable and immediate repercussion of drinking too much. This physical pain is often seen as tolerable so long as the preceding night contained enough social revelry to push off the emotional pain that drives many to drink in the first place. Alcohol became my self-medication, the physical damage I chose to self-inflict in order to gain what little connection I could. In rehab, we bonded together as addicts through Alcoholics Anonymous programming. Under AA ideology, the most important factor to remaining sober is to continue going to meetings, thereby staying connected with the group. It could be said that the success of Alcoholics Anonymous is that it brings people back together and encourages replacing alcohol-based acquaintances with sobriety-based friendships.

We can take note from AA’s success. The critical factor that needs treatment originated back before addiction, before self-medication, before anomie, and before depression. If we are to curb the rising rates of depression and anxiety, we must focus on becoming more socially oriented again. As Martin Luther King, Jr., states, “We must rapidly begin the shift from a “thing”-oriented society to a “person”-oriented society.” This revolution doesn’t need to wait on a system driven by profit to change. It ought to begin with us, as we reach out to those around us and begin to form those meaningful connections that neoliberalism discourages.

At the time of writing, we are facing a state-wide quarantine as more and more countries face the pandemic of COVID-19. This is the perfect time to recognize the ways in which neoliberalism does not support the individual. Like when my father was suddenly without work, millions of Americans are now facing the reality of no social safety net. Panic encourages the populace to hoard and accumulate things, despite expert advice against over-buying. We are quarantined and isolated by necessity, but that doesn’t mean we have to stay disconnected.

It is said that disaster brings out both the worst and the best in people. Perhaps this is a challenge to us as individuals to determine what kind of person we are going to be. Will we be the hoarder, who focus on their own well-being to the detriment of others as neoliberalism and individualism encourages? Or will we reach out in love and help the less fortunate? Will we remain connected during this time, reaching out to our family and friends to remind them they aren’t alone? Will we in solidarity use this opportunity to dismantle the hegemonic beliefs that permeate our daily lives and demand something more?

We are all interconnected. With love comes connection. With connection comes solidarity. With solidarity comes change. We are stronger together.

Works Cited

Chomsky, Noam. “Plutonomy and the Precariat: On the History of the U.S. Economy in Decline”. The Huffington Post, 08 May 2012.

Davis, N. M. “Depression in Children and Adolescents”. The Journal of School Nursing, 21:6: 311-317 (2005).

Fiorentini, Francesca. “5 Ways the U.S. Mental Health Care System is in Crisis”. AJ+, 02 November 2016.

Greenfield, S. F., Reizes, J. M., et. al. “Effectiveness of Community-Based Screening for Depression”. The American Journal for Psychiatry, Vol 154:10:1391-1397 (2006).

Hari, Johann. “Is Neoliberalism Making Our Depression and Anxiety Crisis Worse?” In These Times, 21 February 2018.

Harvey, David. “The Neoliberal State”. A Brief History of Neoliberalism, pp. 64-86. Oxford University Press, 2005.

Hedges, Chris. “American Anomie”. Truthdig, 24 September 2018.

King Jr., Martin Luther. “The World House”. Where Do We Go from Here: Chaos or Community? pp 177-202. Beacon, 2010.

McLeod, Saul. “Maslow’s Hierarchy of Needs”. Simply Psychological, 2018.

McQueen, Humphrey. “Healthcare is not a product, no matter what neoliberalism has taught us”. The Guardian, 22 May 2014.

Monbiot, George. “A Story of Our Times”. Out of the Wreckage, pp. 1-28. Verso, 2017.

Monbiot, George. “Neoliberalism is creating loneliness. That’s what’s wrenching society apart.” The Guardian, 12 Oct 2016.

Twohig, N. and Mariscal, J. “Appendix”. Analytic Tools for Systemic Critique, 2020