Individualizing Illness
A brief analysis of neuroscience, mindfulness, and neoliberalism.
Every epoch of capitalism has been governed by different values and assumptions in the workplace, in institutions, and in social life. The way of being demanded by a specific mode of capitalist society, whether it be the efficient productivity of industrialism or the self-motivated entrepreneurship of neoliberalism, is reflected in and entangled with medical practice, approaches to madness, and manifestations of madness. This essay addresses the latter– the relationship between neoliberalism and the now prevalent focus on mindfulness, chemical imbalances, and medication. I examine the origin and trajectory of the turn towards neuroscience in psychiatric practice, and the ways in which it has been frequently utilized in the growing neoliberal economy as a means of redefining mental health on the basis of the individual. I argue that the neurobiological approach to madness and mental illness has become a very useful method of isolating symptoms within the patient and their genetics, rather than giving focus to social factors and conditions that influence mental states. The push to think of illness as an individual problem, specifically in biological terms, is reflected in contemporary mental health reforms and social programs in the West. While there has been increasing awareness of mental health issues in recent years, this awareness is often enmeshed with a neoliberal ethos of individualism focused on brain chemistry and personal growth, and ultimately works to support the status quo. In a reciprocal sense, neoliberal economic and social conditions exacerbate mental health issues, producing transient illnesses that reflect the flaws of neoliberal governance, in the form of depression, lack of focus, anxiety, and burnout.
The notion of the brain as the primary site of the mind and soul was not invented in the ‘neuroboom’ of the 1990’s, and in fact emerged independently from scientific research in neuroscience. It came initially from traditions of Western philosophy where at certain points, “the self was defined in terms of functions that were associated with processes located inside the head,” This lineage already demonstrates a conflict with the popular view that neuroscience is simply science, and therefore it is objective and empirical. The framing of this subject and the urge to focus on the brain, ultimately “did not derive from neuroscientific investigation but from a conception of personhood,” and every conception of personhood bears specific cultural and philosophical assumptions. As physicians such as John Locke popularized the connection between the brain and mental functions, 18th century scholars and scientists took up interest in understanding the structure of the brain. Various scientific approaches emerged in order to study the brain, from phrenology to pathological anatomy, imbued with the Enlightenment ethos of scientific discovery and total knowing of the subject. While these approaches were not universally or consistently accepted, and existed in a larger sphere of different scientific explorations of the mind, their philosophical grounding has guided and influenced neuroscience today.
Interest in the brain ebbed and flowed along with new technological and scientific developments, gaining significant attention in the 1990’s after George H. W. Bush embarked on measures to fund and publicize neuroscientific research. With thousands of dollars in funding and institutional support, neuroscience now had significant scientific backing. Yet what is fascinating about neuroscience is its consistency across different national and social contexts. While psychoanalytic practices differ greatly in various cities and even within cities, the neuro approach is the same globally. Like other sciences, it holds a “set of assumptions, concepts, and methods,” but more uniquely, it “everywhere derives epistemic and social value from its allegedly validating and making more real or objectively known phenomena that are well documented within the human sciences.” In this sense, neuroscience fully encapsulates the spirit of the Enlightenment that Frankfurt School scholars Adorno and Horkheimer harshly critique, the establishment of itself as the totality of truth based on the empirical and objective standards it created, while erasing its own mythic or subjective qualities. If we follow Adorno and Horkheimer’s argument in Dialectic of Enlightenment, neuroscience too is connected to, or at the least compatible with capitalism and bourgeois thought.
On the most obvious level, neuroscience ushered in many new avenues for profit, with increased use of pharmaceuticals and the rise of a self help industry predicated on mastering the brain. More important, however, is its connection to a mode of capitalist thought and existence, an individualism that has been present in most of Western capitalist history, but become even more ubiquitous following the introduction of neoliberal economic policy. Neoliberalism began strictly as the economic practice of expanding the market to previously public or personal spheres. With these changes in economic practice and commodification of uncommercialized aspects of daily life, it has created new forms of social and productive relations, and a culture that encourages individual choice, self-improvement, and achievement. In the context of a societal focus not only on the individual, but on the individual as holding both the barriers and possibilities for self-improvement, neuroscience fits in quite well. At first glance it may appear that viewing mental illness as biologically determined removes responsibility from the individual, and bears little relation to neoliberalism. But neuroscience, by viewing the brain as the primary locus of illness or health, makes mental illness an individual issue, not necessarily through its scientific research but through its reverberations. As Vidal and Ortega explain, the neuro as a set of assumptions and philosophy of the self, exists both inside and outside medical practice, in the social and cultural. The phrase chemical imbalance has entered public discourse, as has talk of mental exercises, neural networks, and the potential for ‘training your brain.’ The notion that happiness or comfort in one’s existence can depend on retraining your brain from unhealthy practices to healthy ones, on recalibrating from imbalance to balance, encapsulates a vision of the self reflected in both the neuro and the mindful. It is in this connection that two seemingly disparate approaches to mental health, one of the mind and one of the brain, interact and ultimately often function towards delivering the same message: your mental state is largely internal, dependent on you as an individual.
Despite its naming in the mind, mindfulness very frequently incorporates neuroscientific language, locating capacity for resilience in the prefrontal cortex and ability to focus in the hippocampus. The brain, like a muscle, can be exercised, strengthened, and improved. Yet in a world where economic insecurity, alienation, uncertainty, and now disease loom over our lives, is widespread poor mental health a result of muscular weakness or connected to social ills? Neither mindfulness nor neuroscience entirely chalk up mental illness to internal factors. However, when looked at as a whole, mindfulness produces a rhetoric of self discipline, of the ultimate power of the individual to change the way they feel about their life. They provide individual self-improvement as the primary means of combating mental illness, regardless of its causes, shifting the discussion away from broader and structural critiques of the state of mental health in the West that might indict aspects of our economic system, philosophy and way of life.
Mindfulness is now a massive industry, estimated to be around 4 billion dollars. Its ubiquity and profitability have prompted criticisms of its uses, drawing attention to the way in which it privatizes stress and unhappiness, and aligns with the neoliberal project. Initially coming from Buddhist practices of meditation, mindfulness was stripped of its spiritual and ethical aspects, made allegedly irreligious and apolitical. However, in mindfulness, “what remains is a tool of self-discipline, disguised as self-help. Instead of setting practitioners free, it helps them adjust to the very conditions that caused their problems. A truly revolutionary movement would seek to overturn this dysfunctional system, but mindfulness only serves to reinforce its destructive logic. The neoliberal order has imposed itself by stealth in the past few decades, widening inequality in pursuit of corporate wealth. People are expected to adapt to what this model demands of them.” Phrenological self-discipline, which bears connection to neuroscience and its overarching philosophy, was meant to help individuals “cultivate and enhance virtues favored by Victorian society while strengthening their capacity to inhibit vices and pernicious inclinations.” In a similar manner, 21st-century mindfulness initiatives and neurobics aim to enhance in individuals the virtues favored by contemporary society, such as productivity, focus, and resilience. 19th-century attempts to train the brain “wished to salvage an individual and collective moral order” that they saw as being eroded by industrial society, while contemporary neuro ascesis attempts to instantiate “the values of an individualistic somatic culture.” This does not demonstrate a discrepancy but rather a consistency in the purpose it serves– to regulate the certain type of self as required by a certain type of capitalist society.
Mindfulness often overlaps with direct neoliberal economic policy, such as austerity measures and privatization. In 2008, as a London borough council prepared to forcibly evict tenants in social housing, it hired life coaches and ‘spiritual ministers’ to provide them with the tools for emotional resilience in the face of stress– a stress quite literally caused by their surroundings. The UK in particular appears to have a significant focus on personal responsibility in its healthcare and social services, carrying an “emphasis on refashioning the incapacitated citizen, including those with a variety of mental health problems, so as to be able to participate once more in the workforce.” These measures have done little to mitigate mental health crises, but rather provide a cruel and temporary solution to a problem exacerbated by the very system they belong to. It should be further unsurprising that it was the UK, through Margaret Thatcher’s reign as Prime Minister, that pioneered neoliberal economic policy. Demonstrating a remarkable ability to create a closed system, neoliberalism “has not only given us crippling anxiety, but its apparent remedy.” In a society that overwhelmingly emphasizes the ability of the individual to achieve, to adapt, to overcome through self-improvement, is it any surprise that depression, anxiety and attention disorders (perhaps manifestations of a failure to live up to these rigorous standards) are on the rise? In a contradictory logic, the neoliberal ethos that has absorbed psychiatric discourses claims to empower the individual by positing that all barriers are within themself, while stripping them of their power, not only in collective action but in the very ability to conceive that their mental state may, in part, be due to the conditions they live in.
The neuro, the mindful, and the neoliberal do not entirely overlap, and neither are intrinsically wedded to neoliberal economics and culture. They have, however, been used to reify the psychological conditions of a certain economic order, and all share a view of the self that is notably individualistic and Western. It is Western in the sense that both nature and man– which here collide in the totem of the brain, are merely things that can be totally known and classified, manipulated, controlled, and made to work for their master, this Enlightenment man who “knows them to the extent that he can manipulate them.” For all its failings, traditional psychiatry, as the psychoanalyst Alan Stone writes, “still looks for the person.” The scientific psychiatrist, the neurobiologist, looks for symptoms. Of course, in earlier times psychoanalytic psychiatry was the tool through which order and normalcy were enforced, and the neuro turn emerged in reaction to the dominance that traditional psychiatry enjoyed from the 50’s to 70’s. Perhaps the dialectic is inescapable. However, a psychiatry that looks at the person-as-person, rather than person-as-brain/machine, gives more space for the concept that people are made through their experience with the world and others. A dialogic approach provides possibilities for the conclusion that madness is far more complex than mechanistic biology or individual fault. Any attempt to consign madness solely to the psyche or to the brain should be looked upon with suspicion. Yet, what should be universally pushed back upon is the notion that madness is solely confined to the individual, and not contingent on social norms, cultural values, economic conditions, and structures of community as well.
References
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