Mental health under neoliberalism: From self-help to CBT
We deserve better than neoliberal solutions to mental health problems caused by capitalism
The COVID-19 pandemic has undoubtedly impacted every corner of our lives at a rapid pace: millions of Canadians have lost their jobs, many have seen their social supports erode, and countless more continue to experience grief and incalculable loss.
While the presence of the coronavirus itself has stirred anxiety over personal and family health, the economic crisis wrought by the pandemic has been exacerbated by gaps in governmental support, leading to further anxiety over paying rent, securing groceries, and balancing childcare and work. Instead of alleviating the socioeconomic causes of this distress, the federal government has encouraged the ongoing privatization of mental health services through public-private partnerships, many with former Finance Minister Bill Morneau’s human resources and technology company Morneau Shepell.
The increasing prevalence of anxiety, stress, mourning and fear is being aggravated just as mental health has become increasingly corporatized and pathologized. Meanwhile, the reality of mental distress accompanying our capitalist system has been met by a booming self-help industry that says if you work harder, you can be happy.
Jan DeFehr, an assistant professor in the Faculty of Education at the University of Winnipeg, spoke with Canadian Dimension about one of the challenges of the current mainstream mental health movement. “Members of the public lack access to critical mental health knowledge,” she says, “because mental health curricula, campaigns, and resources omit patient, ex-patient, professional, and academic critique.”
This lack of critical mental health knowledge has recently allowed for the smooth roll out of provincial and federal internet-based cognitive behaviour therapy (iCBT). However, according to Ameil Joseph, professor and critical theorist at McMaster University, “online CBT can be a highly profitable way of claiming to provide mental health services without offering the depth and breadth of appropriate, required or necessary services and support for people.” This is beneficial and lucrative because “CBT has a way of suggesting that both success and failure of the model is evidence of success—redirecting blame onto individuals or blaming external factors that CBT does not address. When the model fails, it’s because the person didn’t do the work.”
Out of all the therapeutic delivery methods, how did CBT become one of the only accessible forms of therapy for Canadians?
Distress and deliverology
Over the past three years—and particularly over the past six months—provinces including Manitoba, Ontario, and Alberta, as well as Health Canada, have introduced iCBT. The practice is part of a growing field that emerged over the last several decades, and has garnered support from neoliberal governments, particularly Britain’s ‘New Labour’ Party in the late-2000s.
In the United Kingdom, former Prime Minister Tony Blair implemented sweeping shifts in government service provision, largely stemming from his implementation of influential British educationist Michael Barber’s “deliverology.” Deliverology is a new public management reform initiative, focusing on data-based decision making and evaluation. Under deliverology, performance measurement and targets determine what receives funding. CBT is uniquely compatible with this system, because it provides mass amounts of data and is rigorously structured.
This same reasoning for the use of CBT is what accounts for much of the criticism lodged against it; that structured, universal therapy does little to address root causes.
The justification and rationale for the implementation of the UK’s iCBT program was quite different from the government’s public-facing communications strategy around the initiative. After all, investment in mental health care was a proactive cost-cutting measure. Blair’s Labour Party rationalized £600 million for the rollout of the program, hiring professor Richard Layard—an economist and psychologist who was dubbed the government’s “happiness tsar”—and arguing that once people went through iCBT they would be more capable of getting back to work. As many critics have argued, however, providing such psychological therapies was not about improving the overall mental health of the British population in a holistic manner, but fostering a workforce that was able to maximize productivity while leaving the foundations of mental wellbeing untouched.
Deliverology and iCBT both failed in the UK. Standards developed by delivery units focused on quantitative outcomes, often at the expense of qualitative ones; even if targets were met, it did not lead to any improvement in the overall patient experience. Particularly with respect to health care, patients frequently saw worse outcomes as a result of decreases in preventative services. The therapeutic program in the UK—Improving Access to Psychological Therapies (IAPT)—has repeatedly seen results below targets with only 19 percent of people who enter the program reporting short-term success. Additionally, the program has failed from an economic standpoint. And while CBT remains the top form of therapy as part of the IAPT program, its effectiveness has proven to decrease over time. It has also proven to be limited in supporting people who hear voices, and generally unsuccessful in providing long-term solutions.
Gerald Butts, Prime Minister Justin Trudeau’s disgraced former advisor, first brought Barber to Canada during his time as an insider in the government of former Ontario Premier Dalton McGuinty. Unsurprisingly, during Butts time with the federal Liberals, he brought Barber back, and continued to rely on the pillars of new public management: operating the public service as a private firm.
Positive thinkers don’t use welfare
Morneau Shepell markets its AbiliCBT program by stating, “For organizations, untreated mental health issues can drive costs related to productivity, absences, and disability claims.” And for individuals, “this can mean trouble concentrating at work, feeling helpless and alone, or needing to take time off.” Wellness, according to AbiliCBT, means complete focus and attendance at work.
As you enter AbiliCBT, you are given the option to begin your intake, or begin self-guided sessions. If you choose the self-guided program you are given access to common neoliberal self-help strategies that are clearly targeted at mid- to high-income earners: “Investment Anxiety: Coping with a Volatile Market,” and “Helping Employees Stay Focused During Times of Change and Uncertainty” are two available modules. Notably absent from the self-guided materials is content on experiences of racism, job loss or trauma.
The use of psychology to create better workers is not a new concept. In the late nineteenth century, moral treatment became the norm in psychiatric institutions. This approach promised mythical “cure” rates of up to 90 percent. Moral treatment involved psychiatric “patients” having regular schedules, diets, and (unpaid) work while confined in institutions. These capitalist, Christian and white norms were forced onto “patients,” and became part and parcel of a nation-building exercise to construct the “ideal Canadian” (who does not live with mental “illness”). Expectedly, moral treatment failed, and its decline by the dawn of twentieth century signaled the rise of new biomedical methods of mental health treatment.
The depoliticization of mental “illness”
British writer, philosopher and cultural critic Mark Fisher (who blogged under the moniker K-Punk and passed away in 2018) is well-known for his criticisms of the “depoliticization of mental illness,” which he argued contributed to over-psychologization and the “privatization of stress.” As Fisher saw it, the medical system is under an incredible amount of duress caused by neoliberal capitalism, which has created a tenuous social safety net and a lack of solidarity and community.
It is in this individualistic system that talk therapy exists. This is described by Fisher as “Therapies such as cognitive behaviour therapy [that] focus on early life with the self-help doctrine that individuals can become masters of their own destiny.” Moreover, giving public access to CBT without addressing systemic causes of mental distress feeds the capitalist view that if you just work hard enough, you can feel better.
Joseph explains that, “CBT is widely researched and accepted as it directs focus on the individual and away from systemic, historical, political, structural issues related to mental health and well being.” CBT is the perfect companion to neoliberalism, as it personalizes problems and places responsibility for solving them at the feet of individuals. Joseph continues:
You can erase issues related to employment, housing, education, healthcare, substance use, colonialism, racism, ableism, cisheteropatriarchy and make them about certain people with ‘disorders’ and ‘distortions.’ CBT pathologizes behaviours, thoughts and feelings based on one model or worldview that has a way to individualize all problems.
Aside from concerns about the use of therapy to individualize societal problems, others see therapeutic methods as yet another form of settler colonialism. According to Dr. DeFehr, “Euro-American interventions displace resources for coping already present in cultures around the globe”. The implementation of therapies emerging out of the mainstream psychology movement, she continues, “may disregard the local expertise and wisdom already present within peoples’ family and community networks.”
Pushing for better solutions
The left has been pushing for greater access to mental health care for years, so for many, iCBT could be viewed as an exciting success. However, we need and deserve better, beginning with solutions that target systemic causes of mental distress.
Dr. DeFehr outlines three targets the left should be pushing for instead of exclusively psy-based therapeutic methods. The first is widespread access to critical mental health research. The second is developing community-based solutions that disabled and racialized communities have been demanding (or organizing towards) for decades. Finally, DeFehr insists that “the left must push for alternatives that clearly call for Indigenous sovereignty and massive redistribution of land and wealth. Radical destigmatization involves exposing and confronting ways in which the helping professions themselves bolster white colonial settler-led false benevolence.”
We deserve better than neoliberal solutions to problems caused by capitalism. Building radical futures means we must reconsider how we will support our communities, and work towards healing justice.
Megan Linton is a disabled, occasional writer and graduate student based in Winnipeg and Ottawa. Her research interests focus on sexual citizenship, institutions and disability, with a commitment to disability justice. Find her tweeting about sex and disability @PinkCaneRedLip.