“It wasn’t depression, it was capitalism,” was repeated during the social outbreak of 2019 in Chile. That year there was a lot of talk about mental health, and there was a terrible Monday when three people took their lives in the subway and a headline in the press said: “The pain underground.”
The writer Mark Fisher, who died a couple of years earlier, had circulated the idea that depression was a political issue. It wasn’t a new idea at all; from the disciplines psi many had been pointing out an overmedicalization of life. Like the psychiatrist Allen Frances, who directed a version of the DSM (Diagnostic and Statistical Manual of Mental Disorders), already in 2014 he warned about diagnostic expansion and the tendency to turn everyday problems into pathology. But criticism of the privatization of psychic pain took off in those years with Fisher; perhaps because he did not speak the language of the therapists, but rather a more expansive one, that of cultural criticism. It was an idea that had more appeal than being cured with a pill and surely the mere fact of feeling part of something – that the personal was political – was already something of the cure itself: resting from oneself (although the opposite is often recommended) can help to get out of depressive solipsism and distressing hyperalertness.
But like any cultural phenomenon, the effects are not unidirectional; phharmakon It means remedy and poison at the same time. And an idea, when it is frozen, when it is repeated as a formula, also becomes a sedative. Or stimulating, as appropriate.
The pharmacological revolution in the 1950s had the virtue of emptying the asylums, and the industry moved forward, with the so-called minor tranquilizers, towards people without major pathologies. Depressive reactions, overwhelmed mothers, anxious students could be helped. The enthusiasm changed psychiatric practice, the psychopathological clinic and the understanding of the mechanisms of discomfort were increasingly renounced, orienting practice towards visible and standardizable symptoms. The disciplines psi who adhered to the model, could finally achieve the desired scientific recognition. But it was only in the 1990s, when new drugs appeared that promised “better than better” and fewer side effects, that depression would become “the common cold of psychiatry.” In those years a famous artist stated in a late show American who created better with Prozac.
Chile was not left behind. The anthropologist Clara Han, in her ethnographic study Life in debt: times of care and violence in neoliberal Chile, describes that leap in the return to democracy. International standards were adopted, coverage was expanded, diagnoses were homogenized, and people did not want to know much about community psychiatry because it was considered very ideological. He concludes in his research that the model was far from repairing and containing the traces and ties broken in the post-dictatorship. One of the doctors in charge of the National Depression Program confesses to Han: “The program is more of a tranquilizer for the health system than for the population.”
My memory is that those of us who worked in the nascent National Depression Program in the early 2000s were playing a pious trick. We included all those people who, as an undersecretary later reported—precisely in 2019—were going to have a “social life” at the office, those patients, called polyconsultants, even if we inflated the number. You could always find a depressive symptom and it was the only way they would get help. Until then it was strategy, we did not believe that everyone was depressed. But something changed over the years: diagnoses won over questions and pills over words.
Was it depression or capitalism? It was depression and capitalism. That mental health was depoliticized, like almost everything, is what Fisher came to remember. But it was also a language, or its impoverishment. Psychic pain was stripped of its existential face, of the questions and the responsibility for them; It became a wart, something foreign to the person and had to be removed. The language to deal with existential ills became minimal. It was the language that brought the new century: that of the angels. And Fisher did not warn his followers of that. And the phrase that came together in the explosion, neither.
Depression is chemical, but not all of it is political. However, this does not mean that it is a very personal matter. What each person does with it is what counts. When dopamine or capitalism is accused in a strange way, as if they were an undesirable person who has nothing to do with me, what could be called ego capitalism appears: an ego that does not want to know anything about its conditions of production, in this case, of its drives and contradictions. As much as Freud is beaten – he was never forgiven for reminding us that no one knows himself – his question is totally valid: what do you have to do with the evil you complain about? It appeals to the internal narrator and his freedom, which, by the way, is worn out by the denial of politics but also by its excess when it strips away the solitude necessary to think for oneself. This interiority, which some call mentalization, is what protects us from being turned outward, unprotected against fashions, impulses, external pain but also from the demons that come from within.
The angels do not know about your duels and grudges. Angels do not seek to grow. Does what we call mental health today have anything to do with growing up? It is also not certain that growth will continue to matter in general.
Each era has its symptomatic presentations and the form matters. A little over a decade ago there was a lot of talk about borderline personalitiesmeant being between one diagnosis and another, since the symptoms were as erratic as their carriers. That unknown moved. Today this nomenclature is used less, but the diagnostic categories have fragmented and multiplied. This displacement hides what that name precisely implied: being on the limit. Between what and what? Between childhood and adulthood, Gérard Pommier thought at the beginning of our century. The ability to be alone, to separate without becoming melancholy (so much) or taking refuge in paranoia, to accept that truths are partial and that no one loves us enough to allow us to be idiots, are all psychological operations that we never definitively achieve. We go and come back, but they are necessary so that the pain does not become self-destructive. And that counts for a person, as well as for a society that aspires to democratic life.
There is something else that standardized languages erase. That the transition between childhood and adulthood is painful and that even literature has described how at that stage we sometimes freeze, we cover ourselves with masks, costumes, we take detours to be children a little more. Some hide the body, marking it with signs of imaginary tribes to replace the skin that falls off before a new one grows. Others are saddened and others are distressed. Because becoming sexual is distressing. Also looking out into the world and the duty of inventing a life. These are difficult times to imagine such things, perhaps it was always difficult, but it is not certain that our pills help deeply; although sometimes it is necessary to use them. Nor do those other pills that sometimes come from activism: paths drawn and orthopedic and homogeneous skins to close what still has to grow.
Fharmakon: Medicine can also be poison.
Rosa María Olave, member of the advisory council for the mental health bill for higher education in Chile, warned that the first proposal ran the risk not only of overmedicalizing, but also taking away agency from students in their events and transforming universities in mental health centers. He insists that the emphasis should be on coexistence rather than labels. What happens to our ties? With the ability to resolve conflicts? I would add, what happens to the old formula of seeking to know who we are in dialogue rather than in identity as a label?
The idea of mental health, today on the lips of so many, is not anecdotal, it is the dispute over what we understand by human: consciousness with or without consciousness. The risk is that the depression itself becomes capitalist, even in the mouths of its most strident detractors.