This short essay is an attempt to answer the question ‘what can be done to make it easier for people with mental distress to get involved in left-wing politics?’. As such it needs to be stated at the start that the essay is a complete failure; it raises a lot of questions and issues but is conspicuously short on answers. However, it is important to be clear at the outset about what I am not discussing – the involvement of the Left in campaigning for better Mental Health provision, and a left-wing perspective on mental health issues. Both of these will be touched on in passing but they have been, and are being, discussed and considered by better minds than mine. In contrast I have never seen much, if any, discussion of the questions I am raising (which is not to say this has not occurred – it may be that I have missed it, but I have seen little practical evidence of any application).
Because this is an essay where personal perspective is vitally important I intend to declare my ‘qualifications’ for venturing forth with an opinion. As far as the leftism is concerned I was a 24/7 union activist for 3 years in the 1980s and then involved in various forms of activity until the mid-90s. It may be objected that all this is a long time ago, but as far as I can tell from online activity (which was not around then of course!) and from the Left Unity Conference little has changed as far as it affects the subject of this essay. As far as mental health is concerned I have been subject to bouts of moderate to severe depression since the mid-80s (the coincidence of dates is not entirely accidental) and have been through the mill of the mental health system in terms of a very long list of medications, psychiatrists and psychotherapies (which form a spectrum from harmful to life-saving); I have been hospitalised on 3 occasions and had ECT. I am still a depressive, although am better at controlling it partly through a fuller understanding of trigger factors. Now, although I think this does qualify me to speak as far as being a mental health survivor is concerned, it only qualifies me to speak for myself.
There are two vital reasons for this qualification. In the first place I am a white male from a middle-class background and am therefore privileged – indeed there is nothing like a stay in mental hospital to reveal privilege, because of its loss. I am acutely aware that gender, race, sexuality, physical disability and class play crucial roles in mental health and the experience of those who suffer double (or triple) discriminations will be very different. This is not to say that some experiences do not overlap, but it is to stress that I can only talk from my own position. Secondly, I am talking as a depressive and so ignoring many other forms of mental health problem (although it can be argued that depression is the most common mental health issue). However every depressive is different and every case individual; in particular the nature of the illness and every person’s trigger factors are unique. Despite this I think it is permissible to discuss some fairly widespread issues, especially given the limited nature of the subject under discussion.
I will start with a very obvious but very important fact – depression (and I am going to specify depression for the most part from hereon) is episodic. Anyone who is permanently severely depressed will either be permanently hospitalised or dead and in any case there is nothing that can be done in terms of their participation (I apologise if my gallows humour offends; it is an ingrained habit now). Even after 25 years I find it hard to accept the difference between my functioning and non-functioning states ; this is a major difference between someone with a certain kind of mental health issue and those with physical disabilities. If you have mobility, visual or aural disabilities it is unlikely they will go away. It is worth elaborating on this point, if for no other reason than that the failure to understand it (no doubt deliberate) in ATOS and other assessments is so critical to their inapplicability. The point of never being able to predict one’s mental health – and it is possible for the onset of a severe bout to be extremely rapid, a matter of hours – mean that one’s social life is under strict limitation; to take a minor but highly irritating example booking tickets for some sort of event becomes a gamble. Unless you are rich then it becomes impossible. In the context of our discussion then it is obvious that meetings, demos, conferences and so on are something of a lottery. Yes they can be put in the calendar but attendance is wholly dependant on health.
I want to put this in slightly different terms to emphasise the point further. In my long experience the only person who has seen me when really depressed, leaving aside health care professionals and fellow patients, is my partner (and the issue of the effect of mental health issues on partners is a whole other book). Close friends and family members are just told that I am ill (see note 1). I am very fortunate in having a supportive network, but this means that people do not experience my depression. It is sometimes said that mental distress is an invisible condition; as far as my kind of depression is concerned this is profoundly untrue. It would only take a minute to realise something was very wrong – if you could not tell from an unshaved, unwashed appearance there would be the extreme slowness of movement and above all the inability to speak. When well, I enter into conversation readily – indeed I may be garrulous or verbose. When depressed, I am silent, or speech is a stammering effort. Very obviously this makes participation in any sort of politics impossible; apart from anything else I do not leave the house. Beyond this my mental processes are at a very low ebb so I am incapable of intelligent thought.(Note 2).
If this was the only issue it might, and I emphasise might, be possible to consider steps which could be taken to alleviate the situation; a kind of allowance for total unreliability if I can be a little flippant. The particular point to be appreciated is that one’s failure to meet one’s obligations are a source of guilt which is disastrous for many people with depression – a painful lesson I have learnt and relearnt. However, the issues are far from being as simple as this. If it is possible to generalise about the episodic nature of depression, then the question of trigger factors are far from being so simple. On the other hand it is clear that if engagement in left-wing politics involves trigger factors then we are not only talking about barriers – we are talking about harm, in some cases serious harm. Now of course I am not singling out left-wing politics – work, capitalism, social relations, ATOS, the NHS’s inadequacies – the list is endless. But the subject of this essay is left-wing politics.
I emphasise that we are in an area of individual cases but I have to start somewhere so I will take my own case (which is all I can speak confidently about); I do not think that these trigger factors are in any way unique to me, although their special derivation and application certainly are. Two which have a special application to this essay are social contact and confrontation (I should say that it took many years and the help of a wonderful psychoanalyst to work this now obvious fact out!). If I have too much social contact or am involved in confrontation then I will have a bout of depression. Obviously much of left-wing politics involves social contact – meetings, demos, marches, leafletting etc. – and confrontation – with political opponents and within the Left itself. It was a massive overdose of those factors which were the original trigger for the onset of my depression, although the underlying physiological and psychological elements were pre-existent.
Now these are factors are objective circumstances. Social contact and confrontation are necessary parts of left-wing politics. Yes, it is possible that discourse within the left can be made slightly left rancourous (not that making things easier for those with mental health issues is the only reason for this!) although I would not want to suggest any curtailment of free speech or vigorous debate. But essentially these are objective circumstances which cannot – at least as far as I can discern – be altered.
So is there anything that can be done? Yes. In the first place mental health and an acknowledgement that there are people with a mental health disability who are, or want to be, involved with left-wing politics should be brought in from being a marginalised subject to which occasional lip-service is paid, to being a central part of the fight for equality and against discrimination. As far as I know if this was done it would make Left Unity the first left-wing party to ever do this. I very sincerely hope that nothing I am writing suggests that I am in any way belittling people with physical disabilities; I am in absolute awe of their struggles and participation in the face of difficulties which I cannot imagine. But I am saying that I think mental health disabilities are sometimes overlooked and occasionally ignored; in this particular sense I am invisible because if you saw me at a conference I would by definition be well and therefore indistinguishable – we are, quite literally, absent. Just this promotion of mental health disabilities to a central place would be a great step forward.
Secondly serious consideration needs to be given to ways in which new technology and the internet allow for participation. These forms did not of course exist in the period of my activism. I do not wish to suggest that these can replace traditional forms (I am suspicious of over-claiming for the importance of the virtual) but their great virtue in terms of depressives is that they allow, to a limited extent, for the circumvention of the issues I have discussed above. In particular they allow for participation when well and absence when ill without the kind of serious impacts on organisation which real-life activity involves. Additionally virtual social contact is, in my experience anyway, less hazardous (although far from hazard-free) than actual social contact; certainly it is easier to disengage.
Finally, straying beyond the parameters of this essay, Left Unity needs to get involved in issues of the provision of services, discrimination and the politics of mental health. It is to be hoped that everyone is aware of the extent to which mental health is the Cinderella of the NHS and repeated protestations from both Labour and Tory health spokespeople have done nothing to alter this situation. On the contrary service provision has worsened as a result of cuts. People with mental health issues face ever-increasing discrimination as the rhetoric is ramped up against those who are unable to work or pass the various, deeply discriminatory, ‘tests’ which successive Governments have imposed. The politics of mental health, of which I have a little experience, are difficult and at times divisive. But to risk a broad generalisation it should surely be the position of any socialist party that it is not the individual who is to blame. The direction of mental health provision over the past few years has been all in the direction of CBT (Cognitive Behavioural Therapy). This has a number of advantages for capitalism and capitalist political parties. First, it is much cheaper than proper psychotherapy (of whatever variant). Secondly, it suggests that the individual can ‘cure’ themselves by their own efforts. Thirdly, it is designed to make the individual fit to work rather than being able to deal with their condition in the best way possible.
Now, while I stand by these statements, it is true that CBT does work for some people, especially some with anxiety issues for instance. It is equally true that my own experience of CBT was appalling, mainly because I later found out in analysis that it was wholly inappropriate and bound to be harmful in my case! Nonetheless we do have to get engaged in this sort of discussion, complex and hard as it may be. One thing which everyone agrees on (although in many cases the agreement is wholly formal) is that in the area of mental health, service users and survivors have to be involved in the design of service provision. This means that the Left has to take the issue of mental health politics seriously; there is an enormous amount which feminism, anarchism and socialism (for a start) can contribute to the debate.
The slogan that the personal is political remains one of great value and importance. I believe that it is also true, though not much discussed, that the political is personal. Running through left-wing politics there is a vein of opinion or sentiment which values, or appears to value, people according to their level of commitment. You are expected to give everything to the cause and if you do not do so then you somehow less of a socialist. I would say that this reminds me of macho competitiveness if it were not for the fact that, wholly from the outside, I sometimes read feminist pieces which reflect this kind of attitude (apologies if this causes controversy). Not only do I think this is an unhealthy and misleading attitude which puts people off left-wing politics, it is disastrous for those of us who have the kind of mental distress which I have attempted to discuss here. My hopes for this essay are not that it will be any kind of template but that it might start a discussion and eventually lead to actions which will make Left Unity ground-breaking in another new way.
1. When writing this piece I intended to avoid using the term ‘illness’ but a perceptive reader pointed out that I had not done this. The problem with the term ‘mental illness’ is the underlying implication that one can be ‘cured’ by the correct medical intervention in the way that an infection can be cured by antibiotics. In fact medical intervention and the medical model can ameliorate the symptoms but the underlying reasons for mental distress are societal (which include the psychological) and will not be ‘cured’ until capitalism is replaced with a system which values humanity over profit. On the other hand one must reflect reality and when my partner has to explain my absences she says I am ill because that is what people will understand and accept.
2. Courtesy of the same perceptive reader I realised that I had subconsciously concentrated on the physical side of depression and avoided the ‘mental’ side – thoughts of self-harm, guilt, feelings of worthlessness, the urge to self-medicate etc.; this shows how societal prejudice is deeply ingrained and how much harder it is to write about mental distress, even when writing a piece like this.