Timothy Morton refusing to eat his (nonetheless deleted) words, cementing his position alongside Jeremy Gilbert in the bad take stakes, has given a distinctly bad taste to the rest of the #MedsWorkedForMe campaign that swept Twitter recently, following the publishing of a report declaring that antidepressants do work and their bad rep is detrimental to those people who could benefit from taking them.
This may be true, to an extent, but to discourage the depressed from questioning and approaching their illness and its treatments critically is as dangerous as denying that antidepressants can help at all, which is inevitably what this campaign is doing. (And, for what it’s worth, Morton, any critiques of being anti-antidepressant should be lain at the feet of the disgraced Johann Hari and his attempt at a comeback, not Mark Fisher).
As Mark made it very clear, in one of the most famous passages from Capitalist Realism:
The current ruling ontology denies any possibility of a social causation of mental illness. The chemico-biologization of mental illness is of course strictly commensurate with its depoliticization. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s drive towards atomistic individualisation (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low serotonin levels. This requires a social and political explanation; and the task of repoliticising mental illness is an urgent one if the left wants to challenge capitalist realism.
Causation is one thing but let us not forget about entrenchment.
In the context of Capitalist Realism, this paragraph comes right before Mark goes on to consider the ‘new bureacracy’ of what he calls “Market Stalinism and bureaucratic anti-production.” The drugs might work but the system does not — regardless, the effectiveness of the drugs becomes a signifier for the system at large and so #MedsWorkedForMe becomes little more than a PR opportunity.
The way value is generated on the stock exchange depends […] less on what a company ‘really does’, and more on perceptions of, and beliefs about, its (future) performance. In capitalism, that is to say, all that is solid melts into PR,…
Let me say, for the record, that the meds also work for me. At the time of writing, I’ve been taking citalopram for just over one year and they have been instrumental in helping me cope with my depression. Antidepressants are nonetheless a straw-man for more systemic issues within our mental health services.
(NB: I can only speak from my own experience of mental health services in the UK on the NHS and I appreciate this may be vastly different in other countries.)
Antidepressants, if you want to try them, are pretty easy to get hold of if you’re over the age of 18. The first time I went on them, aged 16 and stuck in a dangerous cycle of gradually escalating self-harm, I referred myself to my GP. I went through a whole rigmarole of psychiatric assessments and whatever else and, after about a year of being questioned and facing untold amounts of skepticism, I was told I could go onto a course of citalopram and six weeks of cognitive behavioural therapy (CBT).
Granted, this is 10 years ago, and by my understanding things have improved since then. Whereas my school counsellor’s file blamed my depression on listening to too much Radiohead and Sonic Youth (I wish I was joking), I get the impression that mental health services in schools are better now and serious mental health issues at a young age are less likely to be dismissed as par for the course when you have erratic pubescent hormones.
That doesn’t mean that there isn’t a long, long way to go.
When I came off antidepressants, it wasn’t by choice. As a young adult, I moved to Wales and, when I tried to get a repeat prescription once I was there, I was denied. Despite now being over the age of 18, I was made to feel completely out of control of my own treatment. I went cold turkey on SSRIs that I’d been taking for over 2 years.
There was no communication between my old GP and my new one. I went back day after day after day, complaining of what I later learned was severe ADS but I was repeatedly dismissed. When I started self-harming again, I was treated like a burden, wasting time, attention-seeking. I stopped eating, started drinking and later ended up in hospital.
I was completely failed by the NHS.
Once I “recovered” (read: deeply repressed my issues), things were okay for a few years. I had one more round of CBT without medication, when the depth of my repressions became apparent to my partner and counter-productive to any attempts at sociality, but I didn’t self-harm for seven years. When Mark’s death ripped the floor out from under me and brought me back to a dark place I almost thought I’d left behind forever, going back on antidepressants was the first thing I did because I knew they worked. Unfortunately, our mental health services still do not.
The problem is not limited to the NHS, of course. There are failings across institutions. The counselling services at Goldsmiths were notably privatised in the last few years and so, following Mark’s death, if you wanted to talk to someone you had to call a number and hit a series of buttons in order to be connected to the right department where you’d be dealt with over the phone. Receiving professional support for acute mental distress following communal trauma was now on the same level as ringing your bank: bureaucratic anti-production epitomised, compounding present distress.
I was given a prescription for citalopram after one meeting with my GP. The adjustment period was really tough but after I mellowed out, they’ve helped me. I have nonetheless never seen my GP again. I wasn’t offered any CBT and couldn’t afford any other alternatives available. Over the past year, I’ve repeatedly had to fight to acquire my prescription. After requesting it online, it has been sent to the wrong pharmacy (twice) and I’ve had to chase it around London myself, with no assistance from the practice in telling me where they’ve sent it, as I panic about having recurring ADS. I’ve also had the pick up my prescription delayed by two weeks (twice), resulting in mild ADS, due to, according to the pharmacist, “a national shortage”…
And doctors are recommending more people start taking them?
Obviously, @the_eco_thought knows nothing, about Mark or the "capitalist palliative". Today's headlines have focused on SSRIs alone, glossing over the euphemistic "proper treatment" which Mark wrote so much about but did not receive (from NHS, his employer, et al.) pic.twitter.com/eWbPRPLVNt
— 🦇 ⤵️🕳 (@xenogothic) February 22, 2018
To reiterate and expand on an earlier tweet, the central contention with Morton’s tweet (that he still can’t quite grasp) is not that antidepressants have an unfairly bad rep — the issue is that there is the wider system that has failed so many, including Mark, and neglecting the central importance of that criticism (in order to promote a book no less) is a huge insult to this person that he supposedly respects.
The #MedsWorkedForMe campaign is an example of so many going along with this same drudgery, mindlessly.
You can acknowledge the benefits of antidepressants without writing QVC-style testimonials on the timeline:
Depression and anxiety used to leave me incapacitated for days on end. Finally got the help I needed and my situation has improved dramatically thanks to proper medication. #MedsWorkedForMe
— Alleged Artist (@zeframmann) February 22, 2018
All this does is allow for a conflation between drugs and wider systemic services and this is counter-intuitive to demands for much-needed improvements:
We love the fact that #MedsWorkedForMe is trending and people are speaking openly about depression. Please RT if you or someone you love has benefited from NHS care when suffering from depression. pic.twitter.com/f4jGh52Ybr
— NHS Million (@NHSMillion) February 22, 2018
Morton can “lovingly” make light of Mark’s death and assume he didn’t take or condone antidepressants, but to do that is not only a disservice to his thought and critique but also to his experience.
Today an inquest heard Mr Fisher and his wife Zoe had sought psychiatric treatment in the weeks leading up to his death, but their GP had only been able to offer over-the-phone meetings to discuss a referral.
The inquest heard Mr Fisher’s mental health had deteriorated since May 2016, leading to a suspected overdose in December where he was admitted to Ipswich Hospital.
After the hearing, Mrs Fisher criticised the Norfolk and Suffolk NHS Foundation Trust’s (NSFT) referral system, saying that on the telephone Mr Fisher was able to convince his GP he did not need treatment.
“We fell foul of a lot of reforms that have taken place, shifting services to different areas,” she said.
“The hospital services are always attentive and on the ball, but once you leave hospital the GP becomes your access to any help.
“It was problematic and very frustrating at times. It is because of the way things are set up.”
During the inquest, coroner Nigel Parsley said although he was not making a formal report about the difficulty the family had in accessing care, he did say he was going to make contact with the Trust about the issue.
These experiences — whether Mark’s or my own — are not unusual. Over the years that I have been involved in mental health systems to varying degrees, either personally or alongside a friend or another member of my family, what we all share is that getting treatment for mental health conditions of all kinds is a constant and uphill battle that only serves to entrench those conditions further. Thatcher’s ‘Care in the Community‘ policy is largely to blame alongside countless other neoliberal policies that further isolate and perpetuate the suffering of those who suffer.
Is it any surprise that people are skeptical about the drugs offered to them so readily when every other part of the system is a mess? Is skepticism over the effectiveness of antidepressents really the issue or do people just not trust the vendors?
This is obviously not to say “do not seek treatment” — if you know you’re unwell, physically or mentally, you’d be daft not to. It is rather to say “demand better and more comprehensive treatment”. So what if the drugs work? That’s not actually going to fix anything. The drugs aren’t a cure. They help you cope. CBT is an exercise in repression rather than an treatment of cause. I could go on but I won’t. Mark’s said it all already.
He once wrote:
Depression is the shadow side of entrepreneurial culture, what happens when magical voluntarism confronts limited opportunities. As psychologist Oliver James put it in his book ‘The Selfish Capitalist’, “in the entrepreneurial fantasy society,” we are taught “that only the affluent are winners and that access to the top is open to anyone willing to work hard enough, regardless of their familial, ethnic or social background – if you do not succeed, there is only one person to blame.” It’s high time that the blame was placed elsewhere. We need to reverse the privatisation of stress and recognise that mental health is a political issue.
His talk of privilege here is in reference to the depressing realities of competitive labour more generally but it could just as easily be read as critique of access to mental health services.
Elsewhere, he wrote:
Collective depression is the result of the ruling class project of resubordination. For some time now, we have increasingly accepted the idea that we are not the kind of people who can act. This isn’t a failure of will any more than an individual depressed person can ‘snap themselves out of it’ by ‘pulling their socks up’. The rebuilding of class consciousness is a formidable task indeed, one that cannot be achieved by calling upon ready-made solutions – but, in spite of what our collective depression tells us, it can be done. Inventing new forms of political involvement, reviving institutions that have become decadent, converting privatised disaffection into politicised anger: all of this can happen, and when it does, who knows what is possible?
#MedsWorkedForMe largely comes across as an exercise in resubordination. It does not sound like a welcoming call for those who are afraid to try antidepressents to come on board and join the club; it resembles a snide declaration to critique no more.
There is no alternative.
It is a campaign that means well, obviously, but what is it realistically going to achieve when the NHS’s underfunded and overly bureaucratic mental health services continue to fail so many of us? Surely the worst thing we could do is walk them so respectably into an undeserved PR hole-in-one. All it demonstrates is a “deeper stratification”.
On that note, any excuse to share lēves’ excellent essay again:
Motives for assimilation may be either deeper stratification in the first instance or post-capitalist desires in the second; for example the desire to be accepted by the popular crowd who have utopia focused on the perfection of the self; or the desire to be part of a undercommons revolt involving “collective utopian politics and the public exercise of utopian virtues” leading to a more harmonious, if still imperfect, social order. Here, a drama of value plays out in an attempt to shift the responsibility away from the ‘self that must get better’ to the necessary expansion of the commons and facilitation of participation – the former being a negative solidarity of “solitary, private, individual” bodies. The latter mode is the anti-capitalist productivity, or commoning, of anxiety that we must mobilise. Both situations can lead to the cut off mode outlined above as the conditions for participation may remain ambiguous. The proposition here is how can we work from anxious experience in order to communicate potential alliances, equalising knowledges and mobilising a more collective politics.
Some wise words from Robin:
And also thank you to lēves for reminding me of this in the comments, all the more pertinent right now as so many at Goldsmiths and elsewhere are on strike over pay and pensions:
It’s also good to see #MedsDidntWorkForMe making a few good appearances, not as a disavowal of the original hashtag, but in order to give a space back to criticality:
I'm happy that #MedsWorkedForMe is trending but its opposite #MedsDidntWorkForMe is equally if not more important. If people are at their nadir and meds either don't work or make them worse (which is not that rare IME) they'll likely feel even more like they're broken & unfixable
— Edwardo-Ka (@edwardo_ka) February 22, 2018
Xenobuddhism’s lengthy comment below is also a must-read addendum here:
A member of the Council, Joanna Moncrieff, has written at manuscript length on how best to account for the psychoactive benefits of medications and has outlined a model of medications as inducing therapeutic chemical imbalances rather than correcting them. In this model the possible scope of medicating illnesses is expanded rather than proscribed and sits comfortably with the continually rising evidence base for substances like MDMA and ketamine as treatments for depression, even as the evidence base for existing medications corrodes. The book is the Myth of the Chemical Cure. I don’t know if Mark ever read this book but he was certainly aware of Moncrieff as we were slated to share a platform with her. Unfortunately she couldn’t attend the event but an essay of her’s, “The Psychological is the Political” was published in the same outlet as Mark’s much read “Good For Nothing.”
I remember having a conversation with Mark where I was explicit about my own support for alternative psychoactive treatments for depression. We had just sat through a screening of a video that a Goldsmith’s audience derided in laughing in response to its argument that entheogenic drugs may be more effective than antidepressants- a line Mark would clearly return to in his idea of Acid Communism (and that is suggested by one famous longitudinal study on the effects of LSD on subjective well-being.) Talking privately, Mark shared my disappointment in that cynical laughter. I never got the sense that Mark was anti-medication and the idea that all critiques of psychiatric drugs amounts to pill-shaming is ludicrous.