We often think of Marx as being very economic and structural. But when I started to read more into his theory of alienation, it jumped out to me that Marx is also quite a psychological thinker. Alienation specifically is a theory that is very focused on the psychic, mental and emotional impact of work under capitalism. The discussion of how work for profit separates us from other works and from our internal desires, and the psychological impacts of not owning the things we produce and not working for the greater good of humanity but instead creating profit. To me, that’s a psychological theory.  

Marx’s theory of alienation is critical to understanding mental health under capitalism. A point I make in the book is that you can call it different things, whether that be mental health or just distress or suffering. When Marx was writing, the concept of mental health, as we understand it, didn’t exist. But when he talks about suffering and alienation, it is a theory of mental health that can be linked to later theorists. I reference Arlie Hochschild, who talks about emotional labour and how we have to split off, such as smiling for customers when you don’t feel like smiling — this is linked to alienation.  

In the book, I also try to make a connection between the concept of alienation and experiences of disassociation, which is more of a psychiatric term. I talk about dissociation a lot because that’s something I experienced when I was having my own mental health crisis. In some ways, alienation describes performance association under capitalism — the way we constantly have to conduct a performance of the ideal student or worker, of someone who has the ideal emotional experiences to function under our economic system. I see this as very relevant to how we think about mental health.  

One of the people I quote in that chapter discusses this regarding Amazon. Doing the same mundane, high-speed, high-pressure task repeatedly all day is incredibly emotionally taxing. We don’t often name it, but emotional performance is a huge part of work.  

This applies to professionalism in desk jobs, too. There are specific ways of speaking and relating to the people around you, and there are subjects that are appropriate or inappropriate to talk about in the workplace. For example, discussing your personal life or your wages might be taboo. These are very rigid ways of relating and emoting. It’s almost like to be a worker, you have to split off.  

This is something that I treat with complexity because I look at the context of Britain quite a lot in the book. I’d be hesitant to argue that feudal society was better than the society we have now. Then again, work under feudal societies seemed to have a degree of autonomy that we don’t necessarily have under capitalism. For example, as you say, being governed by the seasons, as opposed to rigid and more standardised conditions in factories.  

When we look at disability, before the emergence of the factory and the Industrial Revolution, there were many people who could participate in the process of production who, after the dawn of capitalism, could no longer participate. The disability theorist Mike Oliver talks about how deaf and blind people could participate in work to some degree or another, though they might have worked slower and been more orientated around their families. For deaf people, it might be visual observation, picking up skills that way, as opposed to through spoken language. For blind people, he talks about how the familiar home environment allowed them to make their way around more easily. 

Once we had the emergence of the factory, conditions became incredibly rigid. You couldn’t change them or tailor them to each individual. It is the large production line approach. But also, they were incredibly fast-paced. There wasn’t an opportunity to slow down and ask how we can make this work for you as an individual worker.  

As part of the capitalist economic system, Marx talks about this concept of the reserve army of labour and how capitalism hinges on having a reserve army of people who are unemployed and willing to step in and take your job at any time. The precarity means that workers are incredibly disposable. So why would bosses tailor work to each individual?  

During this period, the expansion of the Industrial Revolution, you suddenly see many people who were not previously considered disabled were termed disabled by this new system of economic and social organisation. That applies to the disabilities I’ve mentioned as well as to what we would call madness or mental illness. People who may have been able to produce or be cared for, at least in the home, were suddenly seen as unproductive and unexploitable. What unites these people is not only that they are experiencing suffering but that their conditions interfere with their ability to hold down a nine-to-five job and participate in what we think of as normal work. 

Disability incarceration is completely intertwined with capitalism. So, for example, Bedlam, the world’s first lunatic asylum, dates back to the late thirteenth century. However, when you look at the records from the thirteenth century, there were people from the equivalent of the Charity Commission who would go around and look at institutions like this. And they said there were just seven insane residents there. So, across the whole country, you have seven people incarcerated due to what’s called madness. That’s not many people at all. Most people who were thought of as mad were integrated into the community. Some people were still confined in local houses on the street if the community felt like they posed a danger, but institutionalisation, as we now understand it, didn’t exist at any significant scale. 

It is only with the emergency of the capitalist economic system that we see what Michel Foucault calls ‘the great confinement’ — a huge explosion in the number of people admitted to asylums. The number of patients admitted to Bedlam skyrocketed, and it became so overrun that they had to build more asylums, both private and public. This aligned almost perfectly with the emergence of capitalism and the Industrial Revolution.  

In the nineteenth century, the Government passed two asylum Acts, which mandated the building of asylums across every single county in the country. And so, in this period, you have lots of people being sent to asylums. There’s also something that we have to consider with families; previous to this, families were given a small amount of funding to look after what were called mad family members in the home. But once you get the emergence of a factory system, you get people being pushed into factories to go and work, so they can no longer be at home to look after their relatives. But then you’ve also got the poor laws that strip these benefits from families, so there was no longer funding to stay home and look after people. So where do mad people have to go? There was arguably no place for them to be sent to other than asylums. It’s important to consider that many families felt they had no other solution. 

That’s why I see capitalism as intertwined with disability incarceration, not just madness or mental illness. Physically disabled and mentally ill people were sent to large asylums where they would spend their entire lives. What united the people incarcerated in these institutions was that they couldn’t be assimilated into the new system of production. That environment wasn’t suitable for them.

100 percent. You can see this narrative seeping into the Labour Party. Keir Starmer is always talking about ‘hard-working people’, ‘hard-working families’, and that ‘Labour is the party of working people’, which excludes disabled people who are unable to work.  

Beatrice Alder Burton and Artie Vierkant’s book Health Communism talks very well about this concept of the surplus class of people who are not in work. This might include disabled, mad, mentally ill or criminalised people, who are unexploitable under capitalism. They’re harmed by capitalism in similar ways to how workers are harmed by capitalism, but left-wing politics often overlooks or excludes groups of people who cannot work. Behind this thinking is the idea that our value as humans is measured by our productivity and ability to work rather than our personhood. 

Under neoliberalism, we have seen this marked shift towards this concept of individual responsibility. Previously, mental health was an issue for the state to address. And obviously, they addressed it in quite a violent way. Under neoliberalism, they have discussed mental health as a personal and private issue. 

The cultural theorist Mark Fisher described the concept that it’s our responsibility to address mental health as individuals as the ‘privatisation of stress’, which emerged in the 1980s. It’s this idea that you need to go and get therapy, download your mindfulness app, take up yoga, take up journalling, and do the ever-expanding list of practices we’re supposed to engage in to maintain our mental health. This is seen very much as an individual responsibility.  

We see this mindset when we discuss mental health and the benefits system. The idea that you can just snap yourself out of it and pull yourself up by your bootstraps is a very British approach to managing our emotional states, but it’s also used to accuse people of malingering to get benefits. It’s a way of thinking that ignores that mental health problems are primarily structural issues, and it justifies an approach that says that problems are your responsibility and that you can fix them on your own.  

I think so. There was a huge boom in self-help books during the dawn of the neoliberal era in the 1980s and 1990s. I can see why these approaches have shapeshifted and are growing in popularity. So many of us are struggling and in distress, and we probably won’t necessarily name or describe it. The idea that you can take responsibility, turn your life around, and address the root cause of your suffering is appealing.  

You can see that appeal being weaponised by people like Jordan Peterson. It’s complicated because things like mindfulness and therapy can be helpful, but they’ll never address the root causes of mass suffering and distress. They might be sticking plasters or help some of us feel we have control over our lives. What they can’t do is address the root causes of toxic masculinity, racism, poverty, and so much suffering. 

We’re living, increasingly atomised lives. The ability to make genuine, emotionally fulfilling connections with other humans is increasingly being stripped from our daily lives — and we can see it. The closure of ticket offices is one example of how opportunities for connection are being seen as unnecessary and stripped away. The capitalist approach does not consider community and human connection valuable.  

In the book, I talk about HR and how it came about. When it began, human resources focused on things like the optimal bench layout, rest break intervals, and lighting to make workers produce better. But then, in the mid-twentieth century, as psychology emerged and gained credibility as a discipline, the focus shifted to the optimal cognitive and emotional conditions for work. 

This change in focus accompanied the shift in the economy towards the service sector and away from manufacturing and forms of work involving manual labour. Suddenly, you get things like psychometric testing, where employers attempt to match people’s personalities to the type of work where they’ll be most productive. At the same time, there is an adoption of trends that emerged in the 1970s and 1980s, like mindfulness and cognitive behavioural therapy.  

Increasingly now, in the neoliberal era, we’ve got a real interest in things like workplace mental health initiatives, mental health first aid training, pre-therapy, nap rooms, and expanding lists of practices that are supposed to support worker mental wellbeing. Practising these individually can make many of us feel better and can be pathways to healing. However, if you look at the history of HR and why it came into existence in the first place, its fundamental function is not to make us feel good for the sake of making us feel good; it’s to make us more exploitable as workers. And so that means these initiatives don’t serve to make us experience joy, flourishing, or our ideas of fulfilment, but rather to make us happy and emotionally adjusted enough to be exploited.  

The exploitation we experience at work is so often the thing that damages our mental health in the first place. We end up in a cycle where the site of distress becomes the place we rely on to address it. 

Poverty and inequality are directly correlated with mental health outcomes. When we think about it in the context of suffering, it’s common sense. If you don’t have access to very basic material needs or if you live in constant precarity, that will lead to anxiety and depression. If you’re worried about when your next shift will be or whether you’ll be able to pay the bills, that will cause distress.  

Of course, we see people with power, privilege and wealth struggling with mental health, too. I believe capitalism fundamentally corrodes our wellbeing. No one is immune to capitalism. But the difference is that some people have access to private healthcare and private therapy at the first time of distress. 

With poorer working-class communities, they are subject to long waiting lists on the NHS, and by the time they get support, they may be in severe distress or crisis. By the time they’re at that stage, they’re more likely to be subject to the punitive and carceral effects of the mental health system.

Because I think that these are the structures that can genuinely give workers access to power. I’ve heard so many stories of people being offered group therapy to address a round of layoffs at work and things like that. These initiatives don’t give us access to power. They only serve to make us feel better about the structural conditions we live under while also framing them as inevitable.

Unions give us the ability to get to the root of our suffering, which in the context of the workplace is structural. I see unions as having inherent internal politics on the side of the worker, whereas, with mindfulness and therapy, while good in and of themselves, these practices don’t have internal politics. They can be used for good, or they can be weaponised for bad. It was Steve Jobs who brought mindfulness over to the US and kind of started championing it. He really liked mindfulness for himself as a boss, but he also liked it for his workers because it helped them adjust to their unfavourable working conditions. This lack of internal politics means that you can never really control how these things are used. There’s a reason why bosses hate unions, which is that they shift power in favour of the worker.