Before we start, no, I don't mean "bring politics into" mental health. Politics obviously covers mental health issues, practices, and institutions. However, I've come to realize a certain approach to mental health has taken root in discussions around mental health. This approach is based on the criticism of mental health from an ideological point. It centers on the idea that mental health is treated only as a chemical imbalance in the brain, and that sociopolitical conditions aren't considered. One of the most prominently figures cited for this is Mark Fisher.

“The current ruling ontology denies any possibility of a social causation of mental illness. The chemico-biologization of mental illness is of course strictly commensurate with its depoliticization. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causation. If it is true, for instance, that depression is constituted by low serotonin levels, what still needs to be explained is why particular individuals have low levels of serotonin. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.”

― Mark Fisher, Capitalist Realism: Is There No Alternative?, 2009

This, I think, is true to a degree. Denying the mental or physical results of certain policies benefits the rich. However, this criticism, whether intended by Fisher or not, is often used to reduce psychiatry and psychotherapy to mere, atomized, asocial, apolitical practices.

First of all, this hasn't been true in my case. Sure, I have my criticisms of the procedure and the practitioners, but I've talked about a variety of sociopolitical issues in therapy. I mean, how can you not talk about these issues? There are obviously social patterns in a population, and if they're not bad practitioners, the psychiatrists pick up on them. This doesn't mean that I talked about political theory in my therapy, but among numerous topics, I talked about things like the male gender role, the attached aggression and violence, the effects of emotional repression as a result of traditional roles. I know people who extensively talked in therapy about gender roles, queerphobia, and the associated problems.

Therapy helped me on political issues too. I used to be much more repressed, unable to express my disapproval, unable to handle any conflict. But with the help of psychiatry, I started expressing my opinions, including my disapproval, more and more. This included standing up for myself, and while there are many power structures I can't overcome as an individual, this change helped me better stand up for myself against people who have power over me. It also helps me feel not as much like a piece of shit when I can't, because learning to face my emotions helps me realize I have limits.

But, according to the Fisherian argument I've seen repeated countless times, this isn't what psychiatry does. It just treats you like an asocial animal, which is not true at all. If anything, psychiatry emphasizes, again and again, that humans are social animals, therefore, have social needs, and that not meeting those needs will lead to mental problems. Seriously. Search "humans are social creatures psychiatry" on whatever search engine you use and also on Google Scholar. You'll find, page after page, pop article and scientific article, talking about the importance of this.

The second thing I want to mention is that links between inequality and mental health are an important area of research. You can search for keywords like "socioeconomic status mental health" and "inequality mental health" on Google Scholar to see many articles written about this. You can alternatively replace "socioeconomic status" with "SES" and "mental health" with "mental illness" or a mental disorder of your choosing.

To add further support to my argument, let's look at the textbook "Psychology, Global Edition, 5th Edition" of Pearson, which is a very widely known publisher. It has an entire chapter dedicated to social psychology (Chapter 12). The chapter about psychological disorders, Chapter 14, has the following listed as one of its learning objectives (emphasis mine): "Compare and contrast behavioral, social cognitive, and biological explanations for depression and other disorders of mood."

Let's also look at WHO's mental disorders page (emphasis mine).

"At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function."

I think one of the other negative things about this argument is that, it denies the possibility that some people face mental illness not mainly as a result of social issues, but as a result of some biological unluck. I haven't checked it out specifically, but I think mental illnesses aren't necessarily mainly a result of social conditions or trauma. I can't claim this with certainty, but neither can the opposing side. However, my approach leaves a possibility open for people who may be experiencing exactly this. Therefore, without knowing, it doesn't claim that certain experiences can't exist.

Before I finish, I want to say that I don't deny the existence of bad practice. I've heard many stories of bad psychiatrists, and even if I hadn't, it would be unrealistic to think they wouldn't have such a problem, considering the problems in education and funding. However, my point is, it's not realistic to say psychiatry overlooks the social reasons for mental illnesses. There may be problems, but in no way they are a shared, distinctive feature of the field.

And last of all, this may be harsh but I think it needs saying, Mark Fisher fell victim to suicide. He's not exactly an epitome of healthy coping mechanisms, and his criticisms about mental health should be evaluated with that in mind. I often think intellectualization tends to come in the way of mental health for, well, intellectual people.

Edit: The last paragraph was poorly explained. I further elaborated here.

Good news: I'll be starting my new work in Cape Town, South Africa soon.

Not so good news: I have depression, and is currently on the antidepressant Sertraline.

My question would be the following:

How are prescriptions of the antidepressant handled in the South African health care system? Can I obtain, from either a GP or a Specialist, a sort of "long-standing" prescription, valid for (say) a few months, that will allow me to refill at pharmacies or dispensing GPs, without me having to be referred to a Specialist each time I need a refill? I understand that recurring examinations by a Specialist are likely necessary, but I don't expect those to be frequent, as my condition is fairly stable now.

Also a related question: I'm otherwise young and physically healthy, not affected by chronic conditions except depression. However, it seems that any health insurance schemes there that cover my condition would be rather expensive. Those policies typically include a broad coverage of chronic conditions, most of which I don't foresee a need. For one like myself, what suggestion would you give in terms of health insurance selection?

Many many thanks <3