Crisis, Fantasy & Psychoanalysis: A Critique of Current Mental Health Discourse

This essay is a reflection on the discourse of mental health in our current times; a conversation I’ve been having with myself, and others, that oftentimes feels like screaming into the nothing.

After years of psychotherapy in my early twenties, I have lost the ability to speak about my psyche outside of diagnostic labels and technical terminology, and with the repetitive “ends of the world” that we’ve witnessed in Lebanon since 2019, I lost the ability to speak at all, and all that was left was thinking, but without the words, a silent language that was deafening. With the 17 October revolution, and a few months before it, I noticed that the field of mental health in Lebanon, namely outspoken psychotherapists and NGOs who advocate for mental health and offer services have started rethinking their ways. With that, the “Mental Health is Political” was iterated. Patients and practitioners increasingly drew a causality between psychological distress, and structural violence and detrimental systems, such as capitalism, patriarchy, racism, and therefore, attribute a political quality to mental illness as it seems to largely be a consequence of the world around us. As attractive and informed as this discourse sounds, it remains largely uncritical and reformist, because it stems from a liberal understanding of the psyche and our relation to it, and it aims to find solutions for its ailments using tools that the market creates and regulates. In what follows, I dissect mental health discourse delving into the rhetoric of crisis that it capitalizes on, hence promoting a cruel fantasy. Through this critique, I take into account how “capitalism” has been mindlessly labeled as the culprit of all discontent in recent years, and with every “end of the world”. I consider that critique of mental health discourse and its industry must start with anti-capitalist remarks and not end with them. This task is possible through psychoanalysis because it works to identify, through speech and language, the capitalist structures that organize our psyche, offering an opportunity for a process that counters the imaginative sterility promoted by capitalist discourse through the rhetoric of crisis and the fantasy of eventual happiness that one can attain if they put in the work.

With the rise of the bio-psycho-social model since the 1980s, structures and systems such as the patriarchy, racism, misogyny, sectarianism, and conservative government, are located within the realm of the socio-political that makes individuals fall ill, as it is characterized by violence, injustice and oppression. Consequently, and with the insistence on trauma-informed intervention in recent years, the rhetoric of crisis became a defining characteristic of the conversation on mental health. The argument articulates that, as we endure unprecedented circumstances, we will witness intensified symptoms, more diagnoses, more prescription of anti-anxiety and antidepressant, and more individuals who will seek psychotherapy. A mental health crisis is foreseen.

What is Crisis?

The term “crisis” is often used to articulate the current present, being the main criterion of measuring the severity of economic and socio-political conditions. As residents of Lebanon drowned in multiple crises since 2019, mental health experts and practitioners warned of a mental health crisis. And as an attempt to understand this “crisis” and to mitigate its consequences, efforts are made to explore it within consumerist capitalism and neoliberalism. Situating crisis within this discourse is useful only if it stems from the recognition of crisis as a reifying apparatus of capitalism, rather than a phenomenon that emerges due to systemic malfunction. Furthermore, understanding the “mental health crisis” as a mere consequence depends on vast divisions between the social, political, personal, psychological and cultural. The result is a depoliticized compartmentalization through which capitalist discourse appropriates mental suffering and releases it back as an evidence-based ideological narrative called “mental illness”. In that, capital dictates to us what our dissatisfaction is, where it came from, how to understand it, what to call it, and how to get rid of it, all with the urgency that crisis demands. This is especially evident in the mainstream critique of mental health discourse that has been echoing the “Mental Health is Political” slogan in recent years. The statement looks to challenge the depoliticized nature of current mental health discourse and practice. This falls under the all too familiar umbrella expression “the personal is political”, stressing on the importance of looking at personal matters with a political lens in order to cater to the urgency of crisis. There is absolutely no denial that factors that contribute to psychic pain are political ones, and that the personal may as well not even exist. However, the politicization of mental health cannot be undertaken if the political is only recognized and invited in when the status quo is shaken. Looking at psychic pain should be done away from a separation of the personal and the political, which is a reformist intervention that dilutes opportunities to radically conceive of the psyche as a political arena, and one that manifests in the world we see. 

Crisis and the Production of Meaning

The crisis nomenclature does not particularly refer to the event itself, but to the rearrangements and reconfigurations that occur in response to it, and how that reflects structurally and psychically on subjects. Crisis is how a happening is symbolized in language, and the degree of ideological charge it contains. Events of tragic magnitude such as the 4 August port explosion in Beirut, reveal a significant feature of capitalism and the extent to which it is able to exploit. Capitalism is able to utilize happenings as a means of production: a way to produce crisis narratives. Again, an event marking loss, negativity and absence, is countered with a spike in production, not just of commodity, but also a production and manufacturing of meaning, terminology, pathology and cure. This argument is beautifully illustrated in Todd McGowan’s Capitalism and Desire: The Psychic Cost of Free Markets. 

In the Grundrisse, Marx notes that “capital has no awareness whatsoever of the nature of its process of realization, and has an interest in having an awareness of it only in times of crisis”. I come back to an observation I made at the start of this piece, that the field of mental health in Lebanon has been reevaluating in recent years and in light of the crisis. This introspection itself is a commodification of happenings that took place in the past 3 years, and a (re)production of meaning on what being “mentally ill” is.

The Optimism of Mental Health Discourse is Cruel

In capitalist society, crisis is a fruitful opportunity to produce and multiply to mask the always already missing object that is made to be perceived as having just been lost. This is important in the interpretation of mental health discourse because it allows for recognizing mental health as an object, a commodity; not merely because we pay for it when we purchase therapy, medication or self-care remedies, but because we consume it to erase a negativity and accumulate its opposite. The pursuit of the object itself is a form of attachment to something, and one that is painful. In their book of the same title, Lauren Berlant introduces the concept of cruel optimism, which posits that our attachment to an object is not about the object itself, but what it promises. Therefore, our pursuit of mental well-being in the capitalist neoliberal moment, is a desire for a satisfactory future free from the mental suffering we are experiencing in the present. But why can an attachment to a fantasy or promise of satisfaction be cruel? Optimism is cruel when our attachment is to conditions of possibility that prove to be impossible. In mental health, our optimism is our attachment to the fantasy of healing, well-being, happiness and satisfaction, and what these concepts symbolize. Its cruelty lies in the impossibility of these ideas, once we recognize their congruence with the impossible promises of capitalism. As we desire quantifiable commodities and the fantasies that they convey, we are desiring objects that exist in quantity, and the demand for them increases due to factors, such as crisis, that often determine production and consumption and occupy a large space in the discourse of the present. In the case of mental illness, the quantity is in the binary, or spectrum, ranging from illness to health, and the negative lacking side, the illness, seems more abundant in its lack, when the ordinary no longer malfunctions the same way.

Discourse of the Present & the Negotiation of Fantasy

Our fantasies are in constant mode of compromise, as we adjust and negotiate them, in light of structural pressures posed by crisis, or what is conceptualized as the unordinary. In that, we are continuously updating our fantasy of happiness, to match the circumstances and constraints that crisis creates in a neoliberal capitalist present. Compromised fantasy is a weak fantasy, marked by its decreasing believability. However, although it becomes less convincing, our desire for what it symbolizes remains unchanging. Our attachment to the fantasy of happiness endures, rooted in what isn’t there, and the potential of what can or should be. As we consciously and unconsciously desire happiness and fantasize about it, further adjusting the image we have of it, capital is the organizing structure that makes this negotiation feasible. Capitalism bombards us with methods of making the normal unordinary livable and negotiable through “technologies of patience” as Berlant puts it, that we relentlessly consume. The discourse of mental health is rooted in a fantasy that is increasingly less convincing, ever more compromised, but one that we continuously seek.

Although fantasy may seem always negotiable because our desire for what it potentially holds is infinite, it is prone to obsoleteness when it wears out of believability. Fantasy can break, and when it does, crisis becomes the narrative of the present. In Lebanon, the discourse of the current present is the result of broken fantasies and marked by extended crisis, with happenings taking place at high speed and in close proximity to each other. This is apparent in how we view the events that uncoil in front of us and how we speak about them as we list the October 2019 revolution, the economic crisis, the pandemic, the 4 August port explosion in 2020, and the issuing mini-crises and scarcities that followed, that have lasted around weeks or months before becoming an unordinary normal. When crisis becomes a ridiculous normality, it initiates a cycle of fantasy creation, further engaging our desire with a potential possibility and perpetually laying out fertile ground for commodification, production and consumption.

Psychoanalysis as Anti-Capitalist Intervention

A psychoanalytic reading of capitalism and how it reconfigures human subjectivity in our current crisis-ridden neoliberal times is crucial for engaging with the psyche and its ailments in a non-problem solving manner. There is a need for a reorientation of “mental health” discourse towards a more psychoanalytic direction, allowing for a more productive approach to the praxis of rediscovering the political within the structure of the psyche, and producing or discovering methods through which we can interact with psychic interiority in ways other than only visiting it in order to erase or manage symptoms. Furthermore, psychoanalysis in the clinic allows for an exploration of subjects’ desire and fantasy, key concepts that are necessary to consider when dissecting current discourse and practice of mental health. As I discuss above, mental health (or illness) discourse promotes a unidimensional view of the psyche through the rhetoric of crisis that it makes use of to symbolize the present, endlessly capitalizing on our ever urgent desire for what cannot be attained, and perhaps what does not really exist. It exploits the unconscious and the extent to which it can negotiate fantasy. All of this puts our psyche in a constant state of wearing out, exhausting desire pointlessly towards a nothingness, with the only thing left to be done is consumption of technologies of patience, completely in line with capitalist discourse.

In contrast, psychoanalysis has the ability to challenge this rigid view of the psyche, and to provide, through speech, an opportunity to dwell, to drown in the words and the thoughts, without any promise of healing or subjective expansion. The clinic is where subjects can lament when fantasy is worn out until the point of breaking, by providing space to produce meaning and then toss it away, to interpret, to understand outside of the confines of the imperative of wellness and health. In that, psychoanalysis in the clinic has the power to allow for imaginative praxis, a venture and exercise in suffering outside of ideologically predetermined meaning produced by capitalist processes of accumulating health, well-being and happiness. Analysands are able, through speech, to liberate their imagination, by making meaning and extinguishing it, asking questions and answering them months later, or never. When the ideological hold that capitalism has on our words is challenged, we are able to truly speak, and when we do, we shrink the torturous noise inside our heads.