Bad news: mental illness will still exist under communism. I know saying this makes me an incredible drag. Despite Marxism’s materialist ontology—meaning, we care about physical, knowable reality— communism is a utopian project. As such, it’s essential to look beyond the limitations of the capitalist political imagination. If capitalism says suffering is natural, unavoidable, and mandatory, we need to challenge that. So why, as a communist, do my wildest dreams still include mental illness? How limited my imagination must be! What a dismal utopia!
But what is dismal is not necessarily wrong. Mental illness: not going anywhere. I think that maybe, to people new to this discussion, what I’m saying is obvious for the wrong reasons. People who disagree with me on this deserve better than to be dismissed out of hand. But at the same time, this article might be the first time some readers learn that this is a controversial topic. So before we dig in, some context: I’m going to give a brief rundown of what mental illness and disability even are, including some history of the invention of disability and mental illness as we know it. And then I’m going to explain why, despite the fact that it is in many ways a social construct, it’s not going anywhere.
Mental illness is a kind of disability, and so the terms we use to discuss disability and mental illness have a lot of overlap. One of the more useful models of disability is the social model. According to the social model of disability, disability exists in the Venn diagram space shared between any impairments a person may have and what society is unwilling to accommodate. So, for example, while a person who has lost the full use of their legs is impaired in any society, they are disabled only because our infrastructure is hostile to adaptive equipment like wheelchairs. Despite laws like the Americans with Disabilities Act, plenty of buildings remain wheelchair-inaccessible. That limits what a wheelchair user can do for work. It can mean they might not be able to hang out with friends, or shop, or generally live their life as they choose. That’s just one example. To give one related to mental illness: I’m mentally ill. I have insomnia and periods where my concentration is very poor. Still, I would be more capable of working forty hours per week if I could choose my own forty hours. Most jobs don’t accommodate that, so that limits my ability to participate in the labor force.
The social model of disability applies equally well to physical and mental disabilities. But the fact I can make a distinction—physical disabilities versus mental disabilities—is a little odd, isn’t it? Your brain is part of your body. A mental illness is, therefore, a physical illness. This distinction exists because the concepts of physical and mental illness evolved separately. Physical ailments were recognized as originating in the body (as opposed to being a purely spiritual phenomenon) at least as far back as Ancient Greece, possibly earlier. By contrast, mental illnesses were sometimes attributed to ailments alternately spiritual and physical. Psychological conceptions as we understand them originated in the modern era. Early psychologists were dualists—they treated the mind as an immaterial but extant thing, separate from the body. To some degree, this framing persists. As Marxists—as materialists—we should note that this is not a materialist understanding. The distinction between mental illnesses and physical ones is not one found in nature; rather, it exists because our understanding of the two evolved separately, only to partially converge around the time of the Industrial Revolution.
But moving towards a materialist consensus on mental illness may have done more harm than good. Placing the “problem” of mental illness within the bodies of mentally ill people rather than in their minds (which is in some indefinite, immaterial third location) implies that solutions can also be found within the body. This belief is correct. It eventually led to better treatments—medications and evidence-based therapy. But this new understanding of psychology as concerned with problems of the body was evolving in parallel with the rise of capitalism and the ideologies that justified its cruelty. Doctors of the time may have grasped that mental illness was a brain-based problem, but they still had no proven treatments for it. Mental asylums began to proliferate in the 1600s. If mental illness is a problem within someone’s body, the solution was to simply take that body and isolate it, away from everyone else. Problem solved.
In the 1890s, the first experimental psychiatric surgeries—forerunners of the barbaric lobotomies that continued into the 1970s—were attempted by Gottlieb Burckhardt. Treating mentally ill people’s bodies as problems to be solved made the mentally ill people into problems as well. Just a few years before Darwin, influential economist Thomas Robert Malthus argued that the human population will grow unchecked and quickly outstrip available resources, jeopardizing the entire world. Charity only encouraged the masses to produce more children, and improving living conditions for the bulk of humanity removed environmental pressures like infant mortality that kept the unfit masses in check. Later Malthusians felt that Darwin’s principle of “survival of the fittest” dovetailed neatly with this. If a family could not survive independently—if it was not fit to do so without charity—then logically, the children produced would be progressively more unfit. The result would be an Idiocracy-like demographic apocalypse.
As modern communists, I think we’re able to quickly see where Malthus is wrong. The world as it’s currently structured absolutely pollutes too much to sustain human life in the long term. But overproduction and famine are not “natural.” Both are artificial; both are driven by capitalist greed rather than by the “unfit” taking up resources. We produce more than enough food and have more than enough space and resources to go around. The problem is in the distribution, which, at present, is staggeringly unequal.
To define who, exactly, counted as “less fit” in the 19th century, philosophers and scientists of the time developed degeneracy theory. The less fit are “degenerate” (from “de” meaning “away from,” and “genus,” meaning “species or kind”). The poor were, in this telling, evolutionarily diverging from the human race by a combination of a lack of selection pressures and their own evil and indiscriminate breeding habits. This was their theoretical explanation for the origins of queerness, non-white people, Jewish people, and the disabled. And so the political movement to counteract degeneracy was born: eugenics. It was far from a fringe ideology; over thirty U.S. states passed eugenics laws. In the 1920s, Buck v. Bell established that the state may forcibly sterilize people it deems unfit. That case law has still not been overturned.
Contemporaneously, in Europe, the Nazi party was amassing power while proffering an explicitly eugenicist platform. Nazi asylums sterilized and murdered disabled people, including the mentally ill, in the run-up to the Holocaust.Eugenics didn’t end with the Allies marching into Berlin. It took a took a civil rights movement to discredit it—nominally. In practice, it’s still around. When Kamala Harris ran for vice president, her platform included refunding forced institutionalization—a proposition that amounted to a rollback of civil rights gains. Seriously mentally ill people die between ten and twenty years younger than average, and self-harm isn’t the primary driver of that. Rather, we’re more likely to die of all causes because of a combination of stress and institutional bigotry. Mentally ill people who can’t work are forced into the overcomplicated and underfunded welfare system, condemned to abject poverty. Politicians have little interest in providing disabled people with enough to live on, to say nothing of thriving. This policy of forcing disabled people to live on pittances is underpinned by the same Malthusian principles that drove the original eugenics movement. Eugenics didn’t die so much as rebrand.
There is, in fact, actually a pretty good argument for why mental illness might not exist under communism. Disability is culturally constructed; its construction occurred roughly around the birth of capitalism. The social Darwinist aspects of bigotry are used to justify capitalist exploitation in general, not just the exploitation of disabled people. People who say that mental illness won’t exist after capitalism hope that, under communism, mentally ill people will be truly valued. That they’ll be permitted to work and live how they choose. That access to treatment will be unrestricted. The idea is that if we meet people with impairments where they are, that disability—not impairment, just disability—will disappear. This is a big-hearted and commendable aim.
Here’s why I can’t get behind it.
When we talk about the social model of disability, the term “model” itself means it’s definitionally an oversimplification. A model is not discredited if it’s not useful in all circumstances. Rather, when it ceases to be useful, that’s our cue to use a different tool. There are known limitations to the social model. One of the main objections to the social model is that it estimates each problem—impairment and social pressures—separately. No amount of compassion and accommodation towards people in pain will make pain fun. Even with treatment and sans any barriers, a person in pain still experiences limitations on what they can do. Depression is a similar story—pain hurts and is limiting even without societal barriers. It applies to other impairments. A person who needs help toileting may need someone to help them on a schedule—if that person is stuck in traffic, are they suddenly disabled again for those ten minutes, or are they not disabled because the societal bigotry is gone?
Even with accommodations for my mental illness, I’m still impaired. I can’t always meet commitments I make to other adults, and that limits my adult friendships. Now, it would be wonderful if we could have more friendships where people gave without anticipation of being paid back, where we are accepted without shame. But friendships between people who can give equally have specific joys. They have different qualities; they’re a different experience. That means I live a different life than someone without my impairment. I’m also seen as different from other adults. I am different. The identity model of disability speaks to this feedback loop of how we’re perceived, how that informs our self-perception, and how that changes our behavior. Far from being liberal or idealistic, it’s an analysis of the dialectic between a person and their material conditions. This isn’t anti-materialist; it simply focuses on another aspect of disability on another scale—personal rather than societal.
I don’t propose we replace one model with the other. I propose we use each tool where appropriate. I’m making an additional point, though: I am skeptical that the oppression of disabled people in general would be achieved simultaneous with the dismantling of capitalism.
The claim that ableism itself is culture-bound (that is, it exists only within one culture or set of cultures—in this case capitalist societies) is an extraordinary one. The people trying to make that case are unable to do so without serious omissions and caveats. On my end, all it takes is a single example to show that, while capitalism did create an ableism specific to it (as I outline in the first half of this article), that doesn’t mean other cultures aren’t viciously, violently ableist. Here’s the example I’ll use: the abandoning of sick children as “changelings” or “oafs” (yes, that is where the modern word comes from) across much of pre-capitalist Europe. And that is far from the only example.
If ableism is an evil that can exist outside of capitalism, then capitalism isn’t its sole root cause. Dismantling capitalism will be necessary but not sufficient.
That said, I don’t deny that there are better ways of handling disability than we do now. In an example from our own past (as documented in Abraham’s Melancholy by Joshua Wolf Shenk), Abraham Lincoln was suicidally depressed. This was not a secret during his lifetime, nor was it considered disqualifying. He had sitters to assist him during those periods. In fact, “melancholy” was seen as a sign of wisdom. This was probably the kindest possible handling of mental illness available before the advent of modern medicine. Lincoln is a near-perfect example of what the life of someone who is severely impaired—but not disabled—might look like viewed through the lens of the social model. In modern times, however, someone like Lincoln would be called unfit to lead. Thomas Eagleton was considered for the vice-presidential nomination in 1972 under George McGovern, but he was ruled out because of his hospitalization and treatment for severe depression.
Perhaps our culture could come to a happy medium—provide people with depression with treatment to ameliorate suffering, and allow them to take on and handle responsibilities by offering them social support. But something still sticks in my craw about this. What other marginalization do we imagine might end by the grace and compassionate assistance of the former oppressor? Is that liberation? I think the social model overemphasizes what society is willing and unwilling to tolerate. I think, understood in isolation, without insights from other models, it really limits our imagination as to what’s possible.
My final objection is in line with the minority group model of disability, which “sees people with impairments as a minority subject to stigmatization and exclusion.” I don’t conceive of disability liberation as a singular historical event, after which oppression is over. I see disabled peoples’ impairment as an inherent vulnerability that will require fraught and complex social arrangements and resources to support. I see evidence of resentment and violence across history and in multiple cultures. Our vulnerability may make us targets, no matter what time or culture we live in. Perhaps we should adopt language that describes that historical role (and the social groups created by that history) in a way more comprehensive than is captured by the term “impairment.”
I’d be happy to be wrong. But perhaps, rather than seeing this perspective as a downer, you can see it as a lesson disabled comrades can teach able-bodied leftists: evidence that any just revolution, any new social order, must be constantly and incessantly refined. The establishment of a functioning communist society, by whatever means, will never be a singular victory after which all progress will cease and all peoples will exist in a utopia by default. If successful (and depending on the realities), it would likely be a substantial improvement to our material conditions. But the stubborn persistence of disability should remind us that any massive societal reinvention will be necessarily imperfect and vulnerable—because it will be human. As such, it will demand that we sustain an unending procession towards full human liberation. ♦