Max Henderson
Professor Hoynes
Culture, Commerce, and the Public Sphere
16 December 2018

The Limitations of Mental Health Discourse in the Public Sphere

The dominant paradigms of psychology and psychiatry throughout history have served to restrict the entry of expressions of collective discontent into the public sphere by framing mental health as individualized. Mental health discourse, a potential source of organizing and understanding collective discontent, upon entering the dominant public sphere as a topic of debate, is diffused of its political sentiments due to the dominant frameworks of the public sphere: neoliberal, atomized, depoliticized, hegemonic. Rather than empowering a politicized discourse about mental health, mental health frameworks are utilized for the maintenance of the status quo and the suppression of deliberation into strictly capitalist, individual paradigms. The individualized frameworks of mental health prevent the formation of collective critiques of a late-capitalist society through the lense of psychological discontent and suffering. Counterpublics throughout history have attempted to combat this depoliticization, but are often met with resistance and co-optation. The liberatory potential of a politicized mental health discourse is postulated as the impetus behind its suppression in a stratified, hegemonic society.

Jürgen Habermas’s theory of the public sphere, Nancy Fraser’s critical analysis of Habermas’s original theory, and Michael Warner’s alternate model of Fraser’s counterpublics provide useful tools for understanding the portrayal of mental health in the public realm as well as the function of mental health discourse in the proper functioning of a healthy democracy (Fraser 1990; Habermas, Lennox, and Lennox 1974; Warner 2002). I will discuss these frameworks in the context of mental health discourse, then proceed to elaborate on the dominant ideologies of mental health in the public sphere, the democratic implications of these hegemonic paradigms in a late-capitalist society, and the mental health counterpublics that have emerged, in part as response to these limitations. A definition of the public sphere provides an appropriate starting point. Fraser notes that the “public sphere … designates a theater in modern societies in which political participation is enacted through the medium of talk. It is the space in which citizens deliberate about their common affairs” (Fraser 1990:110). Fraser’s definition, rooted in Habermas’s original work The Structural Transformation of the Public Sphere, provides us with a few key characteristics of the public sphere as political, public, and discursive.

Habermas highlights the crucial role of public opinion in the public sphere in which citizens can effectively exercise criticism and control over state authority. Although mental health discourse has become increasingly prevalent within the public sphere, the depoliticized language of the dominant medical approaches to mental health serve to limit the possibilities of mental health discourse in the public sphere, thereby limiting the necessity for the public expression of discontent and difference in the operation of a healthy democracy. Mental health frameworks limit the expression of public opinion as critique, which is so integral to Habermas’s idea of the public sphere. Robert Asen and Daniel C. Brouwer further note that “three qualities characterize this critical public sphere: access is granted to all citizens; citizens debate openly; and citizens debate matters of general interest” (Asen and Brouwer 2001). Citizens’ must discuss their discontent through the restrictive language of mental health authorities on the matter – structures of psychology and psychiatry, clinical practitioners, and researchers – thereby restricting authentically equal access to all citizens. The authority that is fundamental to the legitimization of mental health discourse (as graduate degrees, at the very least, are required to substantiate one’s claims) undermines the extent to which the expression of discontent maintains the essential characteristic of public that is integral to the public sphere. The institutionalization (more so in the past) and incarceration (very much in the present) of those with mental health disorders further limits the capacity for all citizens to participate equally in discussions of mental health. Those who are most affected by psychological suffering are often most unable to speak as authorities on the matter. Furthermore, mental health discourse in the public sphere serves to individualize these concerns and distracts from the collective reality of mental health concerns as matters of general interest.

Fraser’s perspective provides a “critical theory of the limits of democracy in late-capitalist societies” (Fraser 1990:109). The individualized and depoliticized framework of mental health highlights the limits of democracy, as the language and ideology of mental health is shaped by the profit-motivates of corporatism and neoliberalism. As activist and anti-capitalist critic Mark Fisher illuminates, “the current ruling ontology denies any possibility of a social causation of medical illness … Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism” by supporting the capitalist notion of the atomistic, disconnected individual and promoting lucrative pharmaceutical markets (Fisher 2009:37). Repoliticizing mental health in the public sphere remains a pressing concern for progressive efforts to restore, build, and maintain democracy in late-capitalist societies.

Fraser’s critique of the Habermasian ideal highlights how assuming that the public sphere is only about discussing the common good ignores self and group interests and the ways in which dominant power structures exercise control over the public sphere to shape the dominant discourses as representative and inclusive of all, when in fact they are not. To address this shortcoming of Habermas’s concept of the public sphere Fraser proposes the notion of the subaltern counterpublic, “parallel discursive arenas where members of subordinated social groups invent and circulate counterid courses, which in turn permit them to formulate oppositional interpretations of their identities, interests, and needs” (Fraser 1990:123). Considering mental health patients and those afflicted with mental health disorders as a subordinated group, through their systematic confinement (through institutionalization or criminalization) and stigmatization, allows us to conceptualize movements led by those with mental health disorders – such as the Mental Patients Liberation Front, the Psychiatric Survivors Movement, and the Mad Pride Movement (discussed later on) – as examples of Fraser’s subaltern counterpublics. Fraser emphasizes the emancipatory potential of counterpublics in their dual functions as both “spaces of withdrawal and regroupment” as well as “bases and training grounds for agitational activities directed toward wider publics” (Fraser 1990:124). We can understand mental health counterpublics as spaces in which people can come together in solidarity over their shared psychological suffering and in which they can organize to challenge the dominant frameworks and responses to mental health crises.

Michael Warner in Publics and Counterpublics also provides us with an alternate conceptualization of counterpublics. He challenges Fraser’s use of subaltern to define all counterpublics, noting that not all counterpublics are comprised of people who are of marginalized identities, giving the example of youth culture and artists – groups which exist as counterpublics yet whose participants are often not of subordinate identities otherwise (Warner 2002). Counterpublic participation is not exclusive to those marginalized on the basis of class, race, ethnicity, sexuality or gender. However, a counterpublic as a group can be subordinate in status. Members whether or not they are of a marginalized identity, may be subordinated in mainstream society due to their participation in the counterpublic’s resistance to the ideologies and practices of the dominant public sphere.

Warner’s expansion upon Fraser’s initial framework is crucial for understanding academic fields that have sought to challenge the dominant frameworks from within the privileges of academia. Humanistic Psychology, Critical Psychology, and Mad Studies have emerged as academic schools of thought and inquiry that attempt to use the powers of the university against the neoliberal structures of society that perpetuate hegemonic conceptualizations of mental health. The work of Stefano Harney and Fred Moten sheds light upon the emancipatory potential of counterpublics within universities: “To abuse its hospitality, to spite its mission, to join its refugee colony, its gypsy encampment, to be in but not of – this is the path of the subversive intellectual in the modern university” (Harney and Moten 2013:26).

Fraser further notes that within the public sphere, certain matters pertaining to “intimate domestic or personal life are deemed illegitimate for public debate” (Fraser 1990:131). I maintain that dominant mental health discourses of individualization and depoliticization mirror Fraser’s notion of a “rhetoric of privacy that has historically been used to restrict the universe of legitimate public contestation” (Fraser 1990:131). Contrary to Dahlerg’s standpoint, I side with difference democrat critiques of the Habermasian ideal. I will attempt to argue that the rhetoric of mental health effectively excludes affective modes of communication that would serve to challenge the status quo, such as the expression of discontent, in public sphere discourse. Affective modes of communication are essential for democracy (Dahlberg 2005). The depoliticized discourse of mental health marginalizes the affective claims in the public sphere that originate from oppressed peoples (Fraser’s counterpublic) and/or those that challenge the status quo (Warner’s counterpublic).

Collective concerns of the public sphere are defused by the medicalization of mental health, as originally demonstrated by the formation of psychiatric institutions in response to labor organizing movements. Contemporary socialist magazine Jacobin describes the foundation of psychiatry as a plot by Gilded Age industrialists to frame “society’s ills as problems of individual ‘mental health.’” (Carr 2018). Socialist approaches to collective suffering and societal flaws challenge predominantly biomedical understandings of mental health and point to the origins of psychiatry in the 20th century. Psychiatry began as a mission to suppress labor organizing and collective concerns over class inequality and labor conditions and to place social problems under the expertise and control of depoliticized, ‘objective’ scientific experts through the lense of individualized psychology (Carr 2018).

The conditions under which psychiatric institutions initially formed can be understood through the rampant inequality and social pathology of early 20th century modernism: “vagrancy, homelessness, and begging;” a decline in traditional social networks, and a rapid increase in the number of individuals admitted into mental health asylums. The New Liberal thought, that so effectively dismantled radical political energy and organizing for labor movements into psychiatric management, was premised upon the assumption of society as cohesive and well-functioning, a conceptualization divorced from the reality of the social ills at the time. New Liberals elites offered political ideologies of social integration that manifested in the creation of psychiatric institutions. Such ideologies assumed a vision of society as harmonious and viewed those expressing discontent as merely needing readjustment to the social order. Adolf Meyer, who would become the architect of American psychiatry when the American Psychiatric Association was founded in 1921 with Meyer at the helm, explicitly referred to “class consciousness” as “destructive propaganda” and sought to expand the realm of psychiatry beyond the chronically mentally ill to encompass all of society and medicalize everyday life (Carr 2018). The suppression of labor concerns through the formation of psychiatry in the early 20th century demonstrates how the rhetoric and institutions of mental health suppressed the expression of social critique that is fundamental for the success and health of the public sphere which depends upon the expression of public opinion and critique.

The underlying foundations of psychiatric mental health paradigms of Meyer and the New Liberals, premised upon a maladjustment understanding of social ills and inequality in relation to a supposed harmonious society, became central to Freudian psychology, which replicated the individualization and depoliticization of suffering that psychiatry began. Humanistic psychologists in the 1960s critiqued the adjustment paradigms that were central to Freudian psychology and the underlying premise of an “illusion of cultural harmony” (Grogan 2013:8). The humanistic psychology movement sought to challenge the “pretense of American happiness” that justified psychologists’ orientations towards rehabilitating “fallen individuals to better conform to social expectations” (Grogan 2013:9). The “pathology-oriented values” of psychology were drawn into question, as humanistic psychologists understood such paradigms as mandating conformity and “allowing corporate and government interests to prevail” (Grogan 2013:15). Around the same time that Habermas first wrote about the public sphere in Germany, Humanistic Psychologists were waking up to the fact that psychology was used a means to suppress public sphere deliberation and achieve the conservative aims of the state and capitalism. Although Humanistic Psychology was overwhelmingly comprised of white men, Warner’s notion of counterpublics illuminates how the aims of the movement to challenge the hegemony of mental health paradigms and institutions resulted in an agitational relationship with the dominant status-quo. Critiqued (and rightfully so) for its lack of inclusion of women and people of color, Humanistic Psychology still represented a counterpublic in the sense that its goals and ideas were initially subordinated to and in contestation with the prevailing paradigms of behaviorism and Freudianism.

Even though Humanistic Psychology offered a potential avenue for the rise of a counterpublic to challenge the dominant discourses on mental health – and for awhile was successful, as demonstrated by the appointment of prominent Humanistic Psychologist Abraham Maslow as president of the American Psychological Association in 1968 , ultimately the movement fell prey to co-optation due to its failure to fundamentally challenge the individualism at the heart of their critiques. The well-being concerns of humanistic psychology were adopted as management theory to optimize production and maximize profit rather than placing an emphasis on improving the social conditions of labor (Grogan 2013). Today, humanistic psychology appears very little in discourse on psychology, with often a paragraph or less focusing on the topic in introductory psych textbooks. The co-optation of Humanistic Psychology highlights Fraser’s claim that multiple counterpublics represent greater potential for the liberation of subordinated groups and the proper functioning of a healthy democracy compared to a single dominant public sphere. The inclusion of Humanistic Psychology as the dominant field of psychological thought in the late 1960s represented the beginning of the end as its critical projects were diffused as it lost its subordinate, agitational status.

The depoliticized approaches of original psychiatric institutions and philosophies prevailed, as demonstrated by the contents and goals of the DSM III, published in 1980 by the APA. The DSM III, as the standard for diagnoses and treatments, cemented approaches to mental illness in sciences of “observation and classification” in which a “dispassionate, scientific guide for naming symptoms” became the cornerstone of mental health paradigms, informing practitioners, policy makers, and insurance companies (Davies 2015:174). “In scrapping the possibility that a mental syndrome might be an understandable and proportionate response to a set of external circumstances, psychiatry lost the capacity to identify problems in the fabric of society or economy” (Davies 2015:174). The reductionist approaches of psychiatry in the 1970s were strikingly similar to those of the early 20th century. Psychiatry in the 1970s, just like psychiatry at its origins, did not seek to “heal, listen, and understand,” but rather obscure the causes of disorders (Davies 2015:174). One of the members of the task force responsible for constructing the DSM III, M.D. Henry Pinsker, believed that the psychiatric diagnosis of disorders represented symptoms and obscured the diagnosis of causes (Davies 2015).

The rise of neuroscientific approaches have only further exacerbated the reductionist nature of psychiatry and psychology, as neuroscience has granted these fields with greater scientific authority through increased technological prowess to maintain the dominance of their particular paradigms (Davies 2015). As Dr. Peter Cohen at the University of Amsterdam effectively argues in the context of addiction, “cultural notions of addiction are taken as wholly self evident and then ‘confirmed’ in neurological description of the same” (Cohen 2009). Neuroscientific approaches, including the researchers conducting these inquiries and the institutions supporting them, often fail to whatsoever question the underlying cultural assumptions that inform the paradigms of their research. In doing so, neuroscience merely provides continued evidence to support hegemonic answers to uncriticized questions, decreasing the likelihood of radically critiquing the questions themselves.

Reductionist approaches of psychopharmacology and neuroscience have remained dominant, in the era following the decade of the Brain and the rise of Big Pharma. Understanding “happiness science” as the cultural suppression of discontent through wellbeing optimization (rose-colored glasses), we can look to sociologist William Davies’ claim that

one of the ways in which happiness science operates ideologically is to present itself as radically new, ushering in a fresh start, through which the pains, politics, and contradictions of the past can be overcome. In the early twenty-first century, the vehicle for this promise is the brain. (Davies 2015:6)
The National Institute of Mental Health (NIMH), “the largest funder of mental health research and a longtime [supporter] of the DSM”, emphasized a policy shift towards in 2013 moving certain research funding away from DSM-based models towards Research Domain Criteria (RDoC) models (Sheikh 2015). The DSM has replicated and cemented the reductionist nature of psychiatry. Neuroscientific approaches represent these fields moving even further away from the already “restricted questions and answers” of psychiatric approaches informed by the DSM (Davies 2015:176)) .In the words of the NIMH, the goal of the RDoC is to “bring the power of modern research approaches in genetics, neuroscience, and behavioral science to the problems of mental illness” (Sheikh 2015). The RDoC hopes to further objectify the study and diagnosis of mental health, removing the ‘biases’ and ‘assumptions’ of those tasked with constructing the DSM in an attempt to construct a “theory neutral” approach (Davies 2015:174). However, in doing so, the RDoC program perpetuates the “central [assumption] of [mental illness paradigms] – that mental illnesses are ‘brain diseases’ divorced from subjective experience and society’s values regarding what is and isn’t distressing, inappropriate, repugnant, and morally reprehensible” (Sheikh 2015).

In his book The Happiness Industry, sociologist William Davies discusses the profound consequences of such reductionist approaches to wellbeing on the proper functioning of contemporary democracies. He further discusses the integral role that capitalism has played in maintaining the status quo through these paradigms. In this regard, we can understand the limitations of dominant mental health paradigms in the public sphere through Davies’ critique of the science of wellbeing optimization. The continuity and pervasiveness of reductionist psychological and psychiatric approaches to understanding human wellbeing and suffering (as two sides of the same coin) have been demonstrated beginning with the rise of Meyer’s maladjustment vision for psychiatry, to the publication and critique of the DSM III, up until the present day fixation on neuroscientific approaches, in part demonstrated by the NIMH’s focus on RDoC research. The historical approaches outlined here seek to provide an answer to Davies’ question: “What if the current science of happiness is simply the latest iteration of an ongoing project which assumes the relationship between mind and world is amenable to mathematical scrutiny?” (Davies 2015:7). The contemporary fixation of psychological and psychiatric sciences on wellbeing optimization can be seen as simply a repackaging of the original maladjustment paradigms of psychiatry.

Davies notes that this assumption and agenda have been exploited by “those with an interest in social control, very often for private profit” (Davies 2015:7). In this regard we can understand “the entangling of hope and joy within infrastructures of measurement, surveillance, and government” in our efforts to explore the limitations of democracy in late-capitalist societies through the lense of dominant mental health paradigms (Davies 2015:7). As Fraser notes, “when social arrangements operate to the systemic profit of some groups of people and to the systemic detriment of others, there are prima facie reasons for thinking that the postulation of a common good shared by exploiters and exploited may well be a mystification” (Fraser 1990:131). This fabrication becomes abundantly clear as such when considering the crises of mental health in the United States that have been inadequately addressed by the dominant structures and ideologies that inform mental health discourse. A 1992 book titled We’ve Had 100 Years of Psychotherapy – And the World Is Getting Worse aptly describes the situation (Hillman and Ventura 1992).

We can understand the exorbitantly high rates of unhappiness and depression in the contemporary late-capitalist United States as a result of the “strongly, materialist competitive values” and high levels of inequality that characterize the social framework under capitalism. In this regard – as well as in the ways previously demonstrated that dominant capitalist ideologies promote individualism and the status quo – we can understand the limitations of capitalism in not only failing to address high and increasing rates of mental health disorders but actually creating the conditions that lead to the high rates of these disorders: failures that undermine the continued existence of capitalism itself. Depression rates are significantly higher in highly unequal societies like the United States compared to more equal societies such as Scandinavian nations (Davies 2015). Not only does poverty in these societies exacerbate rates of depression in these societies, but the high levels of inequality manifesting in emotions of inferiority and status anxiety (“relative poverty”) that are subjectively experienced as equally insufferable as poverty itself1 (Davies 2015:142).

Not only do absolute and relative experiences of inequality exacerbate depression, but even the values alone that underlie such a system of inequality, “‘aspirational values’ oriented around money, status, and power,” have been found in psychological studies to lead to higher rates of depression (Davies 2015:143). The claim that the inequality and competitive ethos of the late capitalist United States is much to blame for the crisis of mental health is supported by the fact that “around a third of adults in the United States … believe they occasionally suffer from depression” (Davies 2015:143). Not only is capitalism much to blame for our mental illnesses, but it is also to blame for the suppression of potential collective liberatory projects, starting with the initial capitalist suppression of socialist workers’ movements through the formation of the APA and continued to this date with the growing corporate influence – invested in maintaining the dominance of reductionist psychopharmacological ideologies – over the APA. Prior to the publishing of the DSM-V in 2013, “the pharmaceutical industry was responsible for half of the APA’s $50 million budget … and eight of the eleven-strong committee which advised on diagnostic criteria [for the DSM-V] had links to pharmaceutical firms” (Davies 2015:177)

The exorbitantly high and ever increasing rates of mental illness have been illustrated as having significantly damaging economic effects, creating concerns for policy-makers and workplace managers who are invested in maintaining the capitalist status quo. Davies poses the question: ‘What if the greatest threat to capitalism, at least in the liberal West, is simply lack of enthusiasm and activity?” (Davies 2015:105). The failure to consider mental health concerns as collective and political issues has serious consequences for the continued viability of capitalism. “We have an economic model which mitigates against precisely the psychological attributes it depends upon” (Davies 2015:9). As the origins of psychiatry in the suppression of labor organizing movements would predict, “resistance to work no longer manifests itself in organized voice or outright refusal, but in diffuse forms of apathy and chronic health problems,” costing the United States alone up to $550 billion a year in the form of “active disengagement” from work “(Davies 2015:106). In 2001, the World Health Organization predicted that by 2020 mental health disorders will be the leading causes of disability and death (Davies 2015).

The concerning effects of capitalism and reductionist paradigms on our current mental health crises are even more alarming when considered in the context of the integrity of our democracy. The reduction of people’s subjective experiences to the “objective” paradigms of psychiatry and psychology “is disastrous from the point of view of democracy, which depends on the notion that people are capable of voicing their interests deliberately and consciously” (Davies 2015:224). In this regard, we can see Davies’ argument as one that critiques the dominant paradigms of mental health as fundamentally restricting the deliberation essential to the success of the public sphere. The challenging of dominant mental paradigms as the exclusive means of discussing mental health concerns parallels difference democrat critiques of the exclusivity and hegemony of rationality in the public sphere.

In his 1994 book Descartes’ Error, neuroscientist Antonio Damasio effectively demonstrates that:

Rationality and emotion are not alternative or opposing functions of the brain, but on the contrary, that emotions are a condition of behaving in a rational way. For example, individuals who’d suffered brain damage hampering their emotional capacities were also discovered to be incapable of taking more calculated rational decisions. (Davies 2015:72).
Such a finding challenges the illusion of superiority of rationality over emotion in the Habermasian public sphere and would have profound implications for democratic processes and liberatory projects, were such a conclusion meaningfully incorporated into public debate. The suppression of affective modes of communication in the public sphere not only devalue the expression of emotions but also serve to further oppress subordinated groups, whose ways of speaking might not resemble the privileged, gatekeeping, elitist linguistic methods framed as “rational” and “controlled” speech, as employed by white men who dominate these spaces (Dahlberg 2005). The limiting of affective discourse restricts our ability to “understand and to be understood by other”, thereby discouraging the formation of liberatory projects founded upon collective discontent or critique (Dahlberg 2005). In this regard, mental health counterpublics – even those comprised of white men, to draw upon Warner’s notion of counterpublics – can effectively challenge the subordination of groups by promoting alternative ways of communicating in the public phsere that are more inclusive of emotional expression.

However, as previously shown, public sphere discourse continues to be dominated by mental health paradigms and institutes that emphasize depoliticized objective findings rather than providing space for “our conscious statements of opinion or critique” (Davies 2015:224). “A scientific politics has been channeled, a politics in which hard expertise over the feelings of others replaces the messiness and ambiguity of dialogue” (Davies 2015:77). The reductionist paradigms that inform mental health discourse should not be viewed as simply an “objective science” but rather a highly politicized project that fundamentally restricts deliberation in the public sphere. Such restriction is further exacerbated by the differentials of status and power that, for instance, support research in these fields, grant degrees, fund institutions, and publish their findings.

What is troubling about the situation today is that the power inequalities on which such forms of knowledge depend have become largely invisible or taken for granted. The fact that they combine ‘benign’ intentions (to improve our health and well-being) with those of profit and elite political strategy is central to how they function. (Davies 2015:225).
Those invested in maintaining the capitalist status quo, such as pharmaceutical companies, disguise their suppression of democracy through not only their claims of objectivity but also through claiming that they have our best interests in mind.

Davies notes that scientific inquiries into human wellbeing often manifest as strategies for behavioral control. “The surveillance, management, and government of our feelings is successful to the extent that it neutralizes alternative forms of political and economic representation … if unhappiness can be expressed via instruments of measurement, if success can be understood in terms of quantifiable outcomes, then critical and emancipatory projects are ensnared, and their energies are harnessed” (Davies 2015:242). Davies concludes his analysis with powerful and concerning considerations:
The more fundamental question is what it means for society, for politics or for personal life stories, to operate according to certain forms of psychological and neurological explanation. A troubling possibility is that it is precisely the behaviourist and medical view of the mind – as some sort of internal bodily organ or instrument which suffers silently – that locks us into the forms of passivity associated with depression and anxiety in the first place. A society designed to measure and manage fluctuations in pleasure and pain … may be set up for more instances of ‘mental breakdown’ than one designed to help people speak and participate. (Davies 2015:249)
The reductionist paradigms of mental health must be overthrown to preserve and rebuild our democracy.

In response to the hegemony and suppression of the dominant institutions and paradigms that shape public sphere discourse on mental health, counterpublics have arisen to offer alternative, radical, potentially liberatory projects and paradigms for the discussion of mental health as a collective concern. The emergence of mental health counterpublics can be seen as a challenge to the anti-democratic consequences of dominant mental health paradigms and in that regard can be viewed in support Fraser’s critique of Habermas’s public sphere. Fraser challenges Habermas’s claim that “the institutional confinement of the public life to a single, overarching public sphere is a positive, and desirable state of affairs, whereas the proliferation of a multiplicity of publics represents a departure from, rather than an advance toward, democracy” (Fraser 1990:115). As Fraser notes and has been demonstrated in the context of mental health “in stratified societies the singular public sphere is controlled by dominant ideologies” (Fraser 1990:115). “In stratified societies, arrangements that accomodate contestation among a plurality of competing publics better promote the ideal of participatory parity than does a single comprehensive overarching public” (Fraser 1990:115).

The human potential movement, as previously discussed in the formally embodied practices and principles of humanistic psychology, certainly represents one example of such, but unfortunately the movement lost its liberatory potential as humanistic psychology was co-opted through the rise of neoliberalism. Mad Pride stands out as a contemporary subaltern counterpublic that seeks to destigmatize mental health challenges and expand the acceptance of mental illness beyond more common disorders such as major depression and anxiety to include conditions such as bipolar and schizophrenia (Glaser 2008). Some in the movement seek to reject pharmacological approaches to drugs and promote alternative treatments, in a vein similar to anti-psychiatry movements of the 1970s. A lack of cohesive definition of the counterpublic is a result of members of the movement failing to agree on the goals of the movement. The limits of the non-hierarchical structure in providing a cohesive organizational strategy are reminiscent of the Occupy movement.

Mad Pride efforts to destigmatize mental health and empower those who struggle with mental health can be understood through Fraser’s discussion of the bracketing of differentials within the public sphere. Fraser notes that the bracketing of such differentials, ignoring them as if they did not exist or have an effect on discourse and debate, often results in obstructions to equal participation, such as the informal delegitimization of one’s opinions or the suppression of one’s speech (Fraser 1990:115).

In her critique of Habermas’s ideal of the public sphere, Fraser draws attention to unfounded assumptions which assist in understanding mental health discourse in the public sphere. Fraser notes that Habermas assumes that status differentials can be bracketed and people can be treated as equals (Fraser 1990). The stigmatization of mental health serves to delegitimize the opinions of those with psychological struggles and promotes status differentials between the mentally healthy and the mentally ill. However, in order for such efforts to be successful, destigmatization projects must acknowledge the ways in which destigmatizing one’s affliction with a mental illness does not at all necessarily result in a meaningful inclusion of their opinions in the public sphere, especially with regards to that mental illness. Destigmatization efforts must not only seek to challenge the subordination of those with mental health struggles but also the subordination of the opinions and lived experiences of those struggling with mental health.

Fraser also notes that “subordinated groups usually lack equal access to the material means of equal participation” (Fraser 1990:119) Mad Pride efforts to critique the involuntary commitment of individuals for mental health reasons speak to the fact that prisons are the prevailing mental health facilities in the United States. Those deemed mentally unfit to live in society are deprived of the material means to engage in equal participation, in the sense that they are physically barred from society through incarceration or involuntary commitment and their potential to engage in society post-incarceration is significantly damaged, including but not at all limited to the impaired employment opportunities of formerly incarcerated people.

The patient-centric paradigms of the Mad Pride movement seek to combat the authoritative structures of psychology and psychiatry, raise awareness about the downsides and side effects of psychotropic medication and provide alternative treatments/solutions, and restore agency to individuals. The professionalization of mental health through the fields of psychology and psychiatry serve to invalidate people’s authority to speak about and understand their own experiences. In addition to providing space for the discussion of psychological struggle in the public sphere, the discourse of mental health demands that such discussion be interpreted by higher figures and restricted to scientific language. Fraser notes that a hegemonic public sphere “enclave[s] certain matters in specialized discourse arenas” (Fraser 1990:131). The Mad Pride counterpublic challenges many aspects of the dominant mental health paradigms, from the authoritative and hierarchical structures that restrict discourse to the reductionist approaches thoroughly outlined previously in this paper.

Although Mad Pride critiques of psychopharmacological approaches to mental illness challenge biological reductionism and call into question the motives and integrity of pharmaceutical companies, resistance to medication evokes similar concerns that many raised to the anti-psychiatry movement of the 1970s and represents potential for such the liberatory goals of this counterpublic to be suppressed. Furthermore, critiques to drug-based treatments do not necessarily challenge individualized approaches to mental illness but can similarly fixate on alternative yet decontextualized therapies such as exercise, diet, yoga, meditation, and nature therapies (Davies 2015).

Mad Pride goals speak to the ways in which the dominant paradigms of mental health delegate such topics to only a privileged few (trained psychologists and psychiatrists) and thereby limit the potential for mental health discourse in public spheres. People in the Mad Pride movement are challenging the depoliticization and professionalization of mental health by “publicly discussing their own struggles … to inform the general public” (Glaser 2008). The public expression of mental health struggles challenges the suppression of mental health discourse in the public sphere and better promotes a deliberative arena of discussing matters of common interest. Mad Pride is at risk of being co-opted though, as efforts to destigmatize mental health align with similar objectives in the dominant public sphere (as shown by support from federal government campaign) (Glaser 2008).

Concerns for the co-optation of Mad Pride can draw upon Fraser’s illustration of counterpublics and Gamson’s discussions of visibility. Fraser claims that the Habermasian ideal of the public sphere does not fully appreciate the democratic qualities of equality and diversity enabled by multiple publics. The ideal of a single public sphere ignores the fact that the less powerful are absorbed “into a false ‘we’ that reflects the more powerful” (Fraser 1990:123). The publication of an article in the New York Times discussing Mad Pride in a positive light suggests the mainstreaming and absorption of a counterpublic and a diffusing of the radical, collective concerns of the less powerful (Glaser 2008). Gamson notes

The desires to be recognized, affirmed, and validated, and to lay the cultural groundwork for political change, in fact, are so strong they have tended to inhibit careful analysis of the dynamics of becoming visible. Cultural visibility, especially when it is taking place through commerce, is not a direct route to libreation; in fact, it can easily lead elsewhere. (Gamson 1999:213)
The Mad Pride movement will only substantively form a potentially emancipatory subaltern counterpublic if it consistently and effectively challenges the individualization and depoliticization of mental health. To do so would mean to challenge core ideologies of neoliberalism, a daunting and radically progressive challenge, one that the prototypically liberal New York Times is doubtfully sympathetic to. A further challenge of the Mad Pride movement is to develop a cohesive set of goals and ideas, while also remaining committed to its democratic structure. The lack of a well-defined message and agenda unfortunately makes the Mad Pride movement more susceptible to suppression and co-optation.

The emergence of Mad Studies as a topic of academic interest and study similarly falls prey to a lack of precise or agreed upon definition (Beresford and Russo 2016). Mad Studies, the previously mentioned Humanistic Psychology and the later discussed Critical Psychology, as academic fields, might not fit in so neatly to Fraser’s definition of counterpublics as representing members of subordinated identities. Rather, in the vein of Michael Warner, we can view these academic disciplines as counterpublics in the sense that they challenge the dominant ideologies and are therefore not included in the dominant public sphere. Even if these fields are mostly represented by those with dominant identities, we can see these counterpublics as challenging the power of these dominant identities through their subversive discourse and critical aims and thereby they represent a means in which those have influence and power in the dominant public sphere can exert influence and progressive change, in the vein of Fred Moten and Stefano Harney. We must consider how the subordination of the group itself, or its ideologies, threaten its emancipatory potential.

Beresford and Russo, supporters of the Mad Studies movement who are concerned about the potential for its co-optation, highlight how other progressive, alternative approaches to mental health, specifically those focusing on “recovery” and “peer support” have been criticized for “reinforcing neoliberal and market-driven approaches to distress” (Beresford and Russo 2016). Although originally centering survivors and patients experiences, challenging “traditional professional authority, emphasizing “people’s own agency,” and posing criticisms of “long standing psychiatric assumptions,” these subaltern counterpublics have been co-opted by dominant “political and policy imperatives” (Beresford and Russo 2016). Beresford and Russo also highlight the ways in which the academic context of Mad Studies poses challenges to its progressive goals and critiques of the status quo. Beresford and Russo suggest that the field of Mad Studies can learn from Disability Studies to prevent the movement from being undermined and subverted.

The notion within disability studies that “disabled people [are] ‘not disabled by [their] impairments but by the disabling barriers [they] [faced] in society’” resonates strongly with the work of Michel Foucault in Madness and Civilization, exploring the history of insanity in the West and demonstrating the ways in which the institutionalization of the insane is a recent and unnecessary social phenomenon (Beresford and Russo 2016; Foucault 2001). However, counterpublics premised upon a social constructivist model of mental illness face barriers in contributing to the formation of robust counterpublics in that their lack of expertise in the clinical psychological world represents a means to delegitimize their perspectives. Furthermore, anti-psychiatry, as a social constructivist model for understanding mental health, struggles to find support in the public sphere due to the movement been seeing as denying the validity of people’s suffering and thereby combating anti-stigmatization efforts.

The pervasive depoliticized language and ideology of mental health concerns effectively serves to undermine the “emancipatory potential” of mental health counterpublics, such as Mad Pride and Mad Studies. Furthermore, such movements are burdened by their exclusively sociological approach to the ills of medicalized approaches to mental health, and tend to ignore the benefits of medical approaches to mental health. The realm of mental health concerns is plagued by a lack of critical paradoxical praxis in the dominant and even subaltern public sphere: “Without inner change, there can be no change, without collective change, no change matters” (Williams, Owens, and Syedullah 2016:89)

The field of critical psychology, however, is comprised in large part of practicing clinical psychologists and therefore draws upon the cultural power of psychologists in shaping mental health discourse. Furthermore, critical psychology seeks to address the critical paradox highlighted by the dual, sometimes conflicting and sometimes complementary, needs for individual treatment and social change. The central premises of critical psychology are that the individualized approaches of mainstream psychology overemphasizes individuality to the detriment of marginalized groups and to the benefit of unjust institutions (Fox, Prilleltensky, and Austin 2009). Critical psychology, encompassing a range of radical psychologies including but not limited to Marxist, feminist, black, liberation, and queer psychologies, offers some conceptual tools and language for challenging the depoliticization of the public sphere. Drawing from a multidisciplinary base of theory and practice, critical psychology represents a promising counterpublic to dominant discourses on mental health. Critical psychologies represent meaningfully subaltern counterpublics to the dominant mental health paradigms, especially in that they not only challenge hegemonic ideologies but also draw upon the voices of oppressed people: women, people of color, the colonially subjugated, and queer people. In doing so, these counterpublics challenge the hegemonic suppression of voices and opinions of marginalized peoples in the public sphere while also challenging the hegemonic ideologies of mental health that serve to further their marginalization. Unfortunately, a full exploration of the critical psychology counterpublic is beyond the scope of this paper, given the immense range of topics and liberatory perspectives this counterpublic includes, and remains an important consideration for future study.

The identity-conscious subfields of critical psychology challenge the hegemonic, “white supremacist capitalist patriarchy” that informs mental paradigms and restricts social, democratic progress (Williams et al. 2016:22). Dominant mental health paradigms serve to disenfranchise individuals in the public sphere through the intentional bracketing of difference in a way that subordinates their concerns to collective political ones. In reality, this means that mental health struggles of oppressed peoples are individualized while the affective concerns of those benefiting from white supremacist capitalist patriarchy are seen as legitimate and thoroughly incorporated into public debate. In contrast to the depoliticization of mental health, the intense politicization of certain emotions highlights the ways in which dominant hierarchies of the public sphere are manifested through public deliberation. Particularly the political roles of racism and xenophobia (as emotions of disgust and fear) – through their manifestation in mass incarceration, the school-to-prison pipeline, harsh and anti-rational immigration policies – highlight how white supremacy and patriarchy frame discussions within the public sphere.

Although crucial to this work, an intersectional analysis of these issues is beyond the scope of this paper. I recognize that the discussions presented here of collective organizing around discontent center worker dissatisfaction focus on class and exclude considerations of other categories of identity such as gender, race, sexuality, and (dis)ability. However, I must emphasize not only the importance but the necessity of including an intersectional analysis to understand these questions, as marginalized groups and individuals are those whose voices are most suppressed and whose lives are most negatively affected in a quasi-democratic late-capitalist neoliberal society. The suppression of mental health concerns disproportionately burdens those with marginalized identities, in ways that are compounded by multiple marginalized identities. Such a critical approach must include an intersectional perspective to prevent the subordination of certain marginalized identities within social justice movements, such as the sexism prevalent with anti-racism activism, the whiteness of queer activism, or the racism of white feminism. The dominant paradigms of psychology and psychiatry throughout history have served to restrict the entry of expressions of collective discontent by marginalized groups into the public sphere by framing mental health as individualized.

Critical psychology represents the most promising counterpublic to challenge the depoliticization and individualization of mental health, for it not only challenges these paradigms but also offers alternative practices and frameworks from practitioners themselves. The central aim of the field, then, is to expand the reach of its practices and activism and to expand upon the practical realities within psychology and psychiatry of a critical praxis that balances the treatment of individual suffering with the need for societal change. A fundamental restructuring of mental health discourse remains at the center of democratic projects in the public sphere.


Footnotes

  1. I do not at all mean to ignore the privileges of wealth in the contemporary United States and ignore the hardships endured by those in absolute poverty. Rather, I wish to highlight the truly sick and pathological nature of an economic and belief system that is so oriented around wealth and competition that results in similar levels of psychological suffering between those unable to reliably feed their families and those with steady jobs who measure their levels of success against the exorbitant and grossly wealth of the economic elite.︎



Bibliography

Asen, Robert and Daniel C. Brouwer. 2001. Counterpublics and the State. SUNY Press. Beresford, Peter and Jasna Russo. 2016. “Supporting the Sustainability of Mad Studies and Preventing Its Co-Option.” Disability & Society 31(2):270–74. Carr, Zola. 2018. “Medicalizing Society.” Retrieved December 7, 2018 (https://jacobinmag.com/2018/08/mental-health-psychiatry-class-struggle). Cohen, Peter. 2009. “The Naked Empress: Modern Neuro-Science and the Concept of Addiction.” Gepubliceerd Als: Cohen, P. (2009), Die Nackte Herrscherin. Die Modern Neurowissenschaft Und Das Konzept Der Abhängigkeit. Wiener Zeitschrift Für Suchtforschung 32(3):4. Dahlberg, Lincoln. 2005. “The Habermasian Public Sphere: Taking Difference Seriously?” Theory and Society 34(2):111–36. Davies, William. 2015. The Happiness Industry: How the Government and Big Business Sold Us Well-Being. Verso Books. Fisher, Mark. 2009. Capitalist Realism: Is There No Alternative? John Hunt Publishing. Foucault, Michel. 2001. Madness and Civilization: A History of Insanity in the Age of Reason. Psychology Press. Fox, Dennis, Isaac Prilleltensky, and Stephanie Austin. 2009. Critical Psychology: An Introduction. SAGE. Fraser, Nancy. 1990. “Rethinking the Public Sphere: A Contribution to the Critique of Actually Existing Democracy.” Social Text (25/26):56–80. Gamson, Joshua. 1999. Freaks Talk Back: Tabloid Talk Shows and Sexual Nonconformity. University of Chicago Press. Glaser, Gabrielle. 2008. “‘Mad Pride’ Fights a Stigma.” The New York Times, May 11. Grogan, Jessica. 2013. Encountering America: Humanistic Psychology, Sixties Culture, & the Shaping of the Modern Self. Harper Perennial New York. Habermas, Jürgen, Sara Lennox, and Frank Lennox. 1974. “The Public Sphere: An Encyclopedia Article (1964).” New German Critique, NGC (3):49–55. Harney, Stefano and Fred Moten. 2013. The Undercommons: Fugitive Planning & Black Study. Autonomedia. Hillman, James and Michael Ventura. 1992. We’ve Had a Hundred Years of Psychotherapy-- and the World's Getting Worse. HarperSanFrancisco. Sheikh, Sana. 2015. “The War Inside Your Head.” Retrieved December 14, 2018 (https://www.jacobinmag.com/2015/07/depression-schizophrenia-dsm-nimh/). Warner, Michael. 2002. “Publics and Counterpublics.” Public Culture 14(1):49–90. Williams, Angel Kyodo, Lama Rod Owens, and Jasmine Syedullah. 2016. Radical Dharma: Talking Race, Love, and Liberation. North Atlantic Books.