Depression within Marxism

The Absurd:

In existentialism the Absurd is a simple concept; the meaningless or amorality of the universe, and the attempt of a human agent to assign this meaning, leading to a state of Absurdism. Kierkegaard assigned this meaning⁽¹⁾ through the use of religion or a deific entity that existed beyond the Absurd and thus gave a non-Absurd reality that, while beyond the reach of humans, allowed for meaning to be ascribed and existential tension to be released and moved beyond. Camus rejected this. In The Myth of Sisyphus he declared such a position as “philosophical suicide”⁽²⁾ and then used the example of Sisyphus as an Absurd hero:

“In the last chapter, Camus outlines the legend of Sisyphus who defied the gods and put Death in chains so that no human needed to die. When Death was eventually liberated and it came time for Sisyphus himself to die, he concocted a deceit which let him escape from the underworld. Finally captured, the gods decided on his punishment: for all eternity, he would have to push a rock up a mountain; upon reaching the top, the rock would roll down again leaving Sisyphus to start over. Camus sees Sisyphus as the absurd hero who lives life to the fullest, hates death and is condemned to a meaningless task.”⁽³⁾

Camus asserts that the fate of the worker is confined to a similar Absurdity, “The workman of today works every day in his life at the same tasks, and this fate is no less absurd. But it is tragic only at the rare moments when it becomes conscious.”⁽⁴⁾

This tragedy, the worker becoming conscious of the Absurdity of their situation, may sound familiar to those of you who have experienced, or know those with depression. For those of you who are leftists, the fact that Capitalism can cause such despair may seem second nature. And it should be. This rare moment of tragic realisation can fast become a daily struggle, and can describe the resistance to treatment of some depressed patients. The feeling of hopelessness and lack of agency can be described through Marx’s concept of alienation. The worthlessness can be ascribed through the idea of socially necessary labour time; this creates an abstract of the worker’s labour and requires the treatment of the worker as a cog in the vast machine of Capital, existing only to create exchange value. In this way we can see how many Marxist concepts can be used to derive the possible causes of depressed symptoms.

The Tragic:

As we can see there are clear parallels to be drawn between ways in which Capital sustains itself and how they can affect the mood of those it subsumes. While not applicable for every depressed patient, I believe that there is a link between the cruelty and alienating nature of Capitalism and the ever increasing rates of diagnosis for depression.

This is no new concept, Mark Fisher’s “Capitalist Realism” tackles this subject:

“I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill? The ‘mental health plague’ in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional, and that the cost of it appearing to work is very high.”⁽⁵⁾

As Fisher points out, a huge part of Capital is the removal of community and of social responsibility. The problems of the individual are solely the individual’s problems, self created and self aggravating. We currently have a system where the alienation of the worker is part and parcel with the requirement for each individual to be a completely independent entity, despite the need of Capital for the worker to open their skill pool to generification and become a flexible, faceless tool for the use of accumulating value. In the face of such a stark contradiction we can see how untenable this position becomes.

Worldwide depression, along with co-morbid or related illness, has quickly spread to near epidemic levels; according to WHO and other health organisations, depression affects up to 350 million people.⁽⁶⁾ 60% of the 850,000 people per year⁽⁷⁾ who take their own lives suffer from depression or another mood disorder. Taking a closer look, the rate of diagnosis on depression is higher in more affluent, richer countries. This contrasts heavily with what is usually expected from health care systems in more economically developed countries, where the resources exist to provide comprehensive and effective treatment, as well as more sophisticated prevention methods.⁽⁸⁾ Although the money and infrastructure exists in more developed nations this disparity continues to pervade. While the richest countries routinely have higher survival and treatment rates for every other illness, depression remains an outlier.

Depression as an illness is typified by many symptoms; most obviously the low moods. There are also secondary characteristics which draw from these low moods and help sustain them and are some of the biggest obstacles to the depressive patient in overcoming it.⁽⁹⁾ Self guilt is one; the belief that everything bad that happens to or around you is your fault, creating an incredible amount of hate directed at the self. The clear analogue to self guilt in our society is in the way that it regards the individual agent as a purely rational being who has to bear the weight of anything that happens to them as solely their responsibility.

However, this emphasis on individualism is a losing prospect. Our Capitalist society denies this individualism in its very nature, even as it exults it. The worker is stuck inside an incoherent and powerful system, with false freedoms afforded to help placate and coerce them; the choices at national election which are only vague differences between near-identical ideology, the idea of being a free agent in a labour market which favours the employer and demands submission and, of course, the overt use of consumerism to promote choice and individuality within the confines of identikit products and conspicuous consumption. When the Absurd becomes realised in the depressed mind, this leads to a form of learned helplessness. Acutely aware of their position within the world, alienated from work and answerable to arbitrary, obtuse hierarchies, the only available rejection of this subservience is to shut down. The cognitive dissonance arising from the realisation that “life is what you make of it” is false, coupled with treatment that tries to push the supposed truth of this mantra further as the reason for your depression, is debilitating. This constant reaffirming that control is out of your hands, the requirement to give up power to those above you, leads to the avoidance of stress that is common in depression. Those who shut themselves into their rooms and houses and don’t answer the phone for fear of what is on the other end, have learnt this behaviour through the Capitalist system, a system that privatised our stress and then removed our agency.

From my personal experience and that of others I have talked to, medicine seems holds dear the notion of biological factors or chemical imbalances being key within the diagnosis of the causes of a depressive episode. This can also be supported by data in antidepressant prescription rates^(10)(11) and in the use of antidepressants as a first line treatment in depression.⁽¹²⁾ Second to this comes the obvious despair that can regularly accompany traumatic events, such as the death of a loved one or identifiable causes such as postpartum depression. However these “triggered” episodes are generally short lived. While these episodes can lead to a longer period of depression they are treated as a separate branch, and aren’t indicative of the patient independently developing major depressive disorder as we are discussing here.⁽¹³⁾ Of course, that is not to say this is impossible, I don’t wish to downplay anyones mental health, but even in those cases the cause is clear and the continuation can often be explained through the aforementioned chemical/biological causes. However, there is a clear segment of those who suffer with chronic or recurring depression where neither of these explanations are sufficient. Those who are regularly forced through session after session of cognitive behavioural therapy and drug regimes soon find the fog descends anew, if the treatment has any effect in the first place.⁽¹⁴⁾ Studies put the efficacy of combined CBT and drug treatments, the current course de rigueur favoured by the medical establishment, at anywhere from 47%⁽¹⁵⁾ to 62%⁽¹⁶⁾ or even 85%⁽¹⁷⁾. What is clear is that there are a significant number of patients for whom treatment is ineffective or at best simply “dulls” the symptoms. That this number is so large is an obvious cause for concern and research, yet if you walk into your doctor’s practice today and are diagnosed as depressed, I can guarantee that you will be given a treatment plan of CBT and antidepressant medication. Perhaps you will be transferred to counselling first but, if your symptoms persist, you will eventually be thrust on the path of endless CBT and medication, even in the face of major and recurring symptoms.

Self loathing is another common symptom within depression, along with hopelessness and worthlessness. In this case they arise through the same mechanics as self guilt, and are inexorably tied to this guilt. It is also a result of the inherent inhuman nature of Capital. These factors together leave only the self as the target of hate. Even when the true reason for the depressed mood is realised the system of Capital is decentralised, each component as implicit in oppression as the other, with no clear target for the malaise felt. The hate is internalised, the hopelessness and worthlessness develop through this hate, and create a legitimate lack of hope for a change in situation. When the worries are as far reaching and as existential as they become in cases of those aware of their predicament, the standard therapies and pills become little more than a band aid at best, a further cause of frustration and worry at worst.

(1) Kirkegaard S., “The Sickness Unto Death”, transl. Hong H., Hong E. Princeton University Press (1980), p. 22-28 NB: Most of this book is relevant, not just the section cited here.
(2)Camus A., “The Myth Of Sisyphus: And Other Essays”, transl. O’Brien J. Vintage (1991), p. 28
(3)http://en.wikipedia.org/wiki/The_Myth_of_Sisyphus#Chapter_4:_The_Myth_of_Sisyphus
(4)Camus A., “The Myth Of Sisyphus: And Other Essays”, transl. O’Brien J. Vintage (1991), p. 121
(5)Fisher M., “Capitalist Realism: Is There No Alternative?” O Books (2009) p. 19
(6)http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf
(7)http://www.befrienders.org/info/index.asp?PageURL=statistics.php
(8)http://www.who.int/whr/2000/en/whr00_en.pdf p. 152-187 & 200-203
(9)Wenzlaff R., Wegner M., Pennebaker J., “The mental control of depression: Psychological obstacles to emotional well-being.”, Handbook of mental control, 1993 p. 239-257
(10)Ilyas S., Moncrieff J., “Trends in prescriptions and costs of drugs for mental disorders in England, 1998 –2010” B J Psych, 2012, Vol 200, No 5, p. 393-398
(11)http://www.cdc.gov/nchs/data/databriefs/db76.htm
(12)http://032912b.membershipsoftware.org/libdocuments/Treatment_Resistant_Depression.pdf
(13)http://www.psychiatrictimes.com/sleep-bruxism/content/article/10168/1166991
(14)http://032912b.membershipsoftware.org/libdocuments/Treatment_Resistant_Depression.pdf
(15)http://psychcentral.com/lib/2008/depression-treatment-psychotherapy-medication-or-both/
(16)de Jonghe F., Kool S., van Aalst G., Dekker J., Peen J., “Combining psychotherapy and antidepressants in the treatment of depression“, Journal of Affective Disorders, May 2001, Vol 64(2-3), p. 217-229
(17)http://www.aafp.org/afp/2006/0101/p83.html