In the U.K., capital’s casualties are losing even the space to go mad
Halfway down a quiet street in Finsbury Park, London, Andrew Roberts’s house was full of his dead wife’s art. When they met and married, in an earlier and equally fucked-up decade, they were both teenage patients at a mental health recovery center in the U.K. “Valerie was found wandering in a zombie-like state on a beach, and she was taken to Essex Hall. She was put in the ward for ‘the vegetables’. That was what she was called by doctors, in her hearing, a ‘vegetable’. She wasn’t spoken to except by slaps,” Roberts told me.
Roberts’s front room was dark and close, and stuffed with smudgy paintings and ticket stubs—apparently every piece of paper that Valerie ever touched. “Valerie became withdrawn and was unable to communicate except with her hands—a result of the treatment as much as anything else,” he told me. “She was given electro-convulsive therapy, and the doctors wanted her to have brain surgery.” Together, Andrew and Valerie were able to stay out of the hospital for the most part, and they spent their lives organizing for better rights for people with severe mental health problems in the U.K.
When we met some years ago, Roberts had wild white hair and was deeply anxious that I enjoy the cake he had got for us to share. I was there to interview him about the history of the Mental Patient’s Union, of which he and his teenage bride were founding members. In 1973, “a hundred mental patients attended a meeting in London, and we decided to set up a union,” he said. “Our aim was to represent all mental patients wherever they needed to be represented—we wanted patients to be able to support one another and bargain collectively.” Roberts handed me a piece of soft, sweet stuff, ragged around the edges, on a flowery plate. He had pulled off a chunk of cake from the sponge with his fist. I wondered if there were any knives in the house at all.
Capitalism has always had its casualties. And British capitalism has always been so very modern in its barbarity. The country I was born in likes to think of itself as a thought leader, an innovator on the world stage, “punching above its weight” wherever psychic and physical violence are to be found. There are other places in the world where people who are unable to work for reasons other than immediate physical illness may be treated worse, places where they might be locked away forever or scapegoated for evil. But modern British austerity can function as a bellwether for how global capital sees the future of its human assets, and right now people with mental health problems in Britain are royally screwed.
Time for some historical context. In 1808, the British Parliament passed the County Asylum Act to make sure that people with serious ongoing mental-health issues were held separately in dedicated asylums, rather than required to toil in workhouses. Some of those asylums, which at their peak treated hundreds of thousands of people, were compassionate places where doctors cared about helping their patients recover. But many were precisely the sinister pseudo-prisons that haunt popular folklore, into which you could disappear for decades for behaving a little oddly.
Then, in the 1980s, Thatcher’s governments formalized the process of dismantling the asylums. The valuable land and buildings they occupied were sold, the patients booted out into society with minimal support, and it was all done with the support of liberals and patients’ groups. The mental-health system was exploitative and in urgent need of reform. What happened, however, was not reform. It was devastation. A policy that was supposed to empower people with mental-health difficulties became a way of keeping them in squalor.
In the years that followed the process of systematic abandonment that we now call “deinstitutionalization,” the “Care in the Community” provisions that were meant to replace the asylums were stripped of funding. In the U.K. today, most people with mental-health difficulties who would 30 years ago have been treated in a hospital or asylum are left to fend for themselves. Underfunded mental-health teams do their best to make sure the people who are struggling hardest continue to take their meds and don’t walk into traffic, and a small amount of state benefits provides basic housing and a food stipend. But housing is becoming more and more expensive, and benefits harder and harder to get. London home prices rose by 9.7 percent from July 2012 to July 2013 and rents are spiraling out of control just as the housing subsidies cover less and less of the bills. The community may care, but capital couldn’t care less.
The government’s response has been to redefine sickness and incapacity. Strict new welfare tests ensure that the long-term mentally ill who face losing their homes will be found “fit for work,” deemed “jobseekers” whose joblessness is their fault, rather than the fault of an economy with 1930s-level unemployment and extreme intolerance for anyone whose depression, anxiety, or tendency to see giant spiders walking out of the air conditioning makes them unfit for a rare regular, low-paid nine-to-five job. People with mental-health problems in Britain have nowhere left to go. “Each time something changes in mental-health treatment, some people suffer,” said Roberts. “Certainly there are people today who might have been better off in one of the old asylums.”
Madness is both positional and political. The category of sanity has always been unstable, a description of whatever range of behaviors was considered least bothersome when the medical textbooks were being written. Women who wanted to go to work were once deemed insane, as were homosexuals and political activists. Deviant behavior is still considered treatable, depending on your demographic: Women are twice as likely to be diagnosed with borderline-personality disorder, and black men from deprived backgrounds far more likely to be deemed schizophrenic, both labels that get stamped in indelible scarlet on your medical records.
Sanity is subjective, but suffering is real. And under the present conditions of austerity and hopelessness, more and more people are struggling to cope. The final measure of any mental disorder is usually the degree to which a person’s ability to handle everyday life—to hold down a job, keep a house and put their pants on the right way round—is affected. There are a great many reasons, right now, why it’s harder to do all those things and more, and not all of them can be explained away by chemical imbalance.
Prescribing doctors now have at their disposal the chemical means to alleviate real suffering whose roots are social as well as personal. In Britain, such prescriptions have risen by almost 50 percent in the past five years. Malice doesn’t explain it all: Consider your options, if you happened to be a community doctor sitting in front of the tenth weeping wreck working on the front lines of the service industry for minimum wage that you’ve seen that day. Your patient tells you that he can no longer face going to work. Everything is dull and hopeless. He is racked with anxiety attacks and intrusive, suicidal thoughts. What he needs is a few months off work and a new job that lets him live like a human being. But you can’t write a prescription for that, and if he quits his position, he probably won’t find another one. On the other hand, there are these pills that might keep him going for a few months or years, or however long it takes for the angry, terrified parts of him to shudder and die. What do you do?
You do the only thing you can when you know what happens to people who can’t cope. You write a prescription for SSRIs, put him on the year-long waiting list for state crisis therapy, and pray it works. There is no shelter anymore for the emotional casualties of contemporary capitalism. You work or you die. Prescriptions for antidepressants in Britain have almost doubled in a decade.
For Andrew Roberts and the Mental Patients Union, the daily fight for dignity in care was a strategy of creating care itself; for squatter activists and mental health organizers since the 1980s, claiming space to keep each other well wasn’t just good politics, it was a survival tactic. Austerity has created a new cohort of disability rights activists with nothing left to lose. Having no space left to plot resistance matters a lot less when you have the Internet. If you make it easy for to join a movement without having to put pants on and leave the house, you make it much easier for isolated people with enduring mental health problems to get political.
Paula Peters is a representative of Disabled People Against Cuts. She is multiply disabled and in her mid-40s; I meet her outside the Royal Courts of Justice, the great gray coral reef of an edifice on Fleet Street designed to make scruffier citizens feel drowned in their own insignificance when they come to ask for legal recourse. Peters is part of a protest against the bedroom tax, the latest in a pack of austerity measures snapping its teeth at the sick and unemployed.
The bedroom tax—which even its defenders have largely ceased to call the “Spare Room Subsidy”—was a moralizing measure, part of the enormous package of regressive austerity cuts introduced in Britain over the past two years of Tory rule. The idea was simple: If any person receiving social security has more rooms in their apartment than is deemed necessary, their social-security payments get cut, obliging them to live much more cheaply or move. The problem is that for the tens of thousands of people affected, there’s nowhere to move to: The waiting lists for social housing are already many years long.
The bedroom tax was designed not just to reduce the welfare bill, but to make an example of those whose benefits were cut. Britain has a housing shortage and a costly welfare state, due to high unemployment, chronic low wages, and an unresolved global economic crisis for which British banks are partly to blame. The bedroom tax sharpens a structural economic problem into a attack on the poor and sick, who are now to be considered lazy, luxuriating in more space than they need in some of the most crowded cities on earth. It’s not just about the money. It’s about making sure people with disabilities and mental health problems no longer get the basic space to live.
“In Bromley, there are 1900 people affected by the bedroom tax,” said Peters, nursing tea in a paper cup in the café across the road. “We’ve already had 60 million cut off the services, there’s nothing left. We’ve been decimated.” In Bromley, as in other British boroughs, multiple cuts are not just making it harder to survive on a practical level. The stress and complexity of the new work tests, the assault on hope and dignity as the mentally ill are castigated for not being able to find work that simply isn’t there—all of it is pushing people who are already fragile toward a precipice.
“Two people have taken their own lives, fellow campaigners and friends of mine, rather than face the tests again,” said Peters, staring into her tea. “You turn on social media and another person’s gone. My friend Carol Brooker died on the 16th of December, 2010. She went through the Work Capability Assessment and was found fit for work. She left a note on the kitchen table for her husband, and jumped from Platform Three of Pettsford station.”
The Work Capability Assessment, a Tory extension of an existing scheme to prod welfare recipients back onto the already oversupplied labor market, is a Frankenstein creation of conservative cruelty and progressive bureaucracy. You fill out a long, complicated form begging the state for help, and then you have an appointment where, in 52 percent of cases, you will be found “fit to work” and therefore undeserving of any support.
In the past three years, stories have reached me of wheelchair users who were unable to attend their interviews because they were at the top of flights of stairs; people who were made to walk until they fell down weeping and still found fit to work; women who have been made to strip to show their self-harm scars. All of this comes at a cost of hundreds of millions in processing fees and appeals hearings. If the British state were simply to state that it could no longer be bothered to pay for long-term care for the disabled and mentally ill, that would be no less cruel and a lot more honest. As it is, Atos Origin, the private company being paid to supervised the removal of benefits from hundreds of thousands of disabled people in Britain, was unironically awarded a sponsorship slot at the London Paralympic games.
The lack of housing and welfare support is actively contributing to the mental-health crisis. In 2011, a coalition of leading mental-health charities wrote to the British government to demand mercy. “We’ve found that the prospect of IB [incapacity benefit] reassessment is causing huge amounts of distress,” ran the open letter, “and tragically there have already been cases where people have taken their own life following problems with changes to their benefits. We are hugely worried that the benefits system is heading in a direction which will put people with mental-health problems under even more pressure.”
Michelle Baharier of Cooltan Arts, a self-organized support group for people with mental health problems in London, agreed. “A lot of people, when they go through the process to get personal budgets—well, they just go downhill. It’s not a positive scenario at all, because of the assessment process, it’s so judgmental. [At Cooltan] 26 people who were well have had to go back to hospital, and we’ve had four suicides.” A few weeks later, she emailed me with an update: five suicides.
For some conservatives, suicide is never political. It’s simply a “mental-health issue,” and mental health exists in a sphere hermetically sealed from social actuality. If you crack up under the pressures of working life and the indignities of poverty, well, you just need the spirit whipped back into you by mandatory work for a starvation wage, and if that doesn’t sound like health to you, don’t worry. It soon will.
Last month, the British Chancellor of the Exchequer announced that people claiming out-of-work benefits would soon be made to work menial jobs for 30 hours at a rate far below the minimum wage, with no guarantee that they will be able to keep their homes. After two centuries, Britain is back to where it was before the Act of 1808, when those unable to handle the rigors of the new economic order were kept in workhouses to pick rope and tread grain until they collapsed.
At the time of writing, a conservative police commissioner recently suggested that the unemployed be made to work in labor camps for “two years of hell.” That he did so without immediately being obliged to seek new employment himself is indicative of the descent of British public discourse into the kind of twisted kitsch that has produced Dickens’s most mawkish melodrama. “If they would rather die,’’ said Scrooge, “they had better do it, and decrease the surplus population.”
Whether it’s a measure of sanity to work for poverty wages for 20 years without complaint to hang onto substandard housing in a former social democracy that has forfeited whatever claim to humanity it once had is no longer an important question. The question is whose suffering matters, and whose pain is being hallucinated as moral collapse. In Britain, a reaping is taking place. Disaster capitalism is cannibalizing its casualties, and suffering is reframed as sin to obviate the actuality of despair. But despair has always been political—and so has rage.
