mental illness

Chris Burford cburford at gn.apc.org
Sat Jul 1 23:42:29 MDT 1995


First Carrol,  I was glad to see your recent postings on other matters.
I tend to expect women to be direct but usually to avoid the macho
put downs, that sometimes waste time on this list.

Secondly I appreciate your frankness in illustrating
human vulnerability to mental illness. One other person, a man, has
written to me privately about trying Prozac for dysphoria.

I hear your account of your recurrent illness as your experience in the
way that makes sense to you. Obviously there is no way I can know and
respect the detail of your own experience but you have been brave enough
to give it as an example of a general point and I would like to comment
on this in a way that I believe is relevant for marxist ideas.

Clearly I am unusual in contributing energetically to this list as a
psychiatrist. I do so I believe as a bit more than a self-indulgence,
because I believe there is a sense in which non-deterministic psychology
is truly scientific and non-deterministic socio-political analysis is
also truly scientific. The battle for me is to carry through a paradigm
shift in the model of science from the mechanistic to the relativistic.
I believe that Marx's use of the dialectic was the best scientific idiom
of the nineteenth century for this purpose, and in the main I believe
such a re-reading is consistent with his purpose.

Now the parallels. Although according to epidemiological surveys in the UK
25% of the population have distressing psychological symptoms in any one
year (usually forms of anxiety, depression, insomnia etc), you have come
to expect a depressive illness that is more than this and is recurrent.
At any one time 3% of the population have a depressive illlness, and
another 3% have an anxiety state severe enough to be regarded as an
illness. Perhaps ten to fifteen members of this list are struggling
with symptoms that they find disabling to some extent. All of us know
from personal experience or the experience of friends and relatives how
some sort of mental decompensation periodically, is part of the human
condition.

I do not think however that I am merely playing with words in turning
to the question of economic depressions.

Students of capitalism, whether socialist in their aspirations, or servants
of the status quo, all expect depressions to occur in the economy. One
hundred and fifty years of observations lead us to expect such depressions
as inevitable. We all know we cannot be sure of the timing but the
phenomenon seems determined. It seems determined in a way that could be
consistent with the mathematical paradigm of "deterministic" closed
systems that produce indeterminate, unpredictable results that are better
analysed in terms of probabilities.

There is a neurological basis for the recurrent depressions of the global
economy. It is none other than 5.4 billion times 10^11 neurones. It will
not be cured with Prozac.

What I am arguing against is Cartesianism in new clothes. Why say your
distressing recurrent depression is neurological? Your neurones are
firing frenetically as your read this. Mine, as I touch the keys. Why is
mental illness "neurological" and not mental happiness? There is in fact
a neurological basis of course, how could it be otherwise, for laughing,
crying, falling in love, giving up, copulating, and being drawn to
posting on e-mail bulletin boards.

Just because a pattern seems uncontrollable does not make it
pre-eminently neurological. The word conveys I suggest something different-
the feeling of being out of control and helpless. That can be brought about
as much by the momentum of a vast dynamic as by a malfunction of
the slow-running jet of the carburettor of your car.

Carrol, from your description of your unpleasant experiences, it sounds
to me that you have not had the limited benefits of a socialised medical
system, with a general practioner who would try to put your disorder into
context. You have gone straight to a specialist, a neurologist, had a
highly sedative antidepressant, amitriptyline, that probably made your
eyes blurry with the side effects, but did calm the anxiety and worry
and brought some relief before it may have lifted depressive symptoms.
According to your own account you only went to a psychiatrist despite the
hints of the neurologist, to discuss chemicals. It is not clear to me
that you have had a psychological assessment as to what may contribute to
this recurrent pattern. I hope I am not out of order in saying this. We
could discuss it privately, but you had the courage to refer to your
experience as an example you felt of a biological causation.

It is not accidental that in marxist politics the Althusserians have
borrowed Freud's concept of overdetermination to guard against simplistic
and reductionist causal explanations. Your recurrent patterns, are the
product of many causes. I do not personally find Freudian psychotherapy
very useful but at times I feel it is scientific
to note that we are likely to react in ways throughout our lives according
to patterns deeply grooved by the experience of our earliest and most
important relationships.

But there are more proximal psychological assessments that may be relevant.
I do not blame you for trying to keep your experience of depression a bit
in a conceptual box that makes sense to you, in order to be able to
continue working creatively in your department of English. But if you want
a focussed operationalised way of tackling the difficulties, there are
widely available paperbacks of a fairly sober nature using quick-acting
cognitive and behavioural methods for tackling depression and anxiety.

They work, but they work better if shared with a significant other person.
That in my opinion is because we are social animals and even quick acting
commodity remedies, like tablets, or a ten-dollar self-help book, work only
in the context of our being wonderfully complex self-organising systems,
inseparable from our social matrix.

The remedy for the recurrent depressions and other recurrent disorders of
the global economy is to treat it not just as existing at the neuronal
level of the interaction of price mechanisms (cf fiddling with the chemical
neurotransmitters) but seeing it as a social phenomenon mediated by the
law of value, which must with subtlety and resolute political
determination, be brought under global, democratic, social guidance.



Chris Burford, community psychiatrist, London.


>>>>>>

From: cbcox at rs6000.cmp.ilstu.edu (Carrol Cox)
Date: Thu, 29 Jun 1995 23:36:16 -0500 (CDT)
Subject: Chris Burford on "Mental" Illness

    I have (I think) suffered from unipolar depression for 50 years or more (I
am now 65). I happened to be regularly seeing a neurologist for migraine when
the depression (finally) began to be totally destructive. He tried two
different medications, and the second one (an old favorite, amitryptiline)
worked, more or less, for sevral years. I had (at the neurologist's suggestion)
switched to a psychiatrist, but all he did (and all I wanted him to do) was
keep track of my medication and vary it as needed.

    I'm in a downward spiral again the last few weeks, paxil and depakote
having lost some punch. Unless I can get it under better control it looks as if
I'll have to retire at 66 instead of 70 as I had planned. (Incidentally, I was
56 when I first took medication for depression.) It seems to me to be not a
"psycho"-social but a neuro-social disease. "Psych" as used in various
compounds seems to me to still carry too much of its earlier force of "soul."
And the attempt to deny a neurological basis for most mental illnesses seems to
me a retreat to religion. To say it has a neurological basis is not, of course,
to deny that in given instances the social may not be overwhelmingly important:
if you have a leg amputated, it is social relations which will determine how
catastrophic that is for one's life as a whole, and it is social relations (not
some mysterious "psychic force") which will determine how such an injury
affects one's conception of oneself.
                        Carrol Cox
                        Dept. of Englishniversi
                        Illinois State Univ.


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Chris Burford, London.





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