Social Activism and the Economics of Mental Health

Yves here. I must confess to not knowing that participation in social activist groups was a prescription ofr depression. First, there is a very strong base of evidence that shows that regular exercise is very effective in alleviating mild to moderate depression, so I am curious to see remedies with less solid research backing being recommended widely instead. Since most people are extroverts, it’s not hard to see the intuitive appeal of getting them out of the house and out with people as a mood-lifter. And for those whose depression was triggered or intensified by a personal setback, getting out and seeing that others are worse off may restore a sense of proportion. But still….

By John Picton, a lecturer at the University of Liverpool where he specialises in non-profits, donation and the law, particularly as they relate to politics. Follow him on Twiter at @JohnPicton5. Originally published at openDemocracy

Apolitical volunteering is ill-equipped to address the structural causes of depression.

‘Social prescribing,’ where patients with depression join in community activities as a part of their treatment, is moving from the fringe of medical practice to the mainstream. Matt Hancock, the new British Minister for Health and Social Care, has pledged £4.5m to promote it, but we should stop to think before we take this medicine: linking patients to their communities is a positive step, but a better move would be for people to get involved in social activism.

The Minister probably has one eye on his budget, since social prescribing is thought to stop patients coming back to doctor’s surgeries—so saving the state money in the National Health Service (NHS). But this scheme, which normally involves referring the patient to a link worker who then recommends different types of community activity for them, is about more than balancing the books: in fact the NHS is administering a large dose of social theory.

Almost 20 years ago, the American Political Scientist Robert Putnam published Bowling Alone. Since then there has been a groundswell of interest in its central concept of ‘social capital’—the idea that community bonds such as those developed in bowling leagues in the USA make both individuals and societies happier and healthier.

Putnam is a nuanced writer, but the core focus of Bowling Aloneis on community participation not social activism. He wants to unify us not cause political fights, and hopes to develop a country of association-joiners: religious service attenders, sports club players, park gardeners, members of knitting circles and school governors. In one interview he analogises this to a honeycomb, a social system of welcoming and interlocking groups, each empowered as a part of a greater civic whole.

Charismatic, and with the enigmatic appearance of a nineteenth century preacher, Putnam has become an academic celebrity. His ideas on social capital have been met with great enthusiasm by policy makers on both sides of the Atlantic. One British policy group working right at the heart of the Cabinet Office has called him the most influential political scientist alive. Before his promotion, Hancock held the British Government’s brief for civil society, and the influence of Bowling Alonecan be clearly felt in his new policy on social prescribing. Linking individual depression to a lack of community activity takes a leaf straight out of Putnam’s book.

At core the idea is simple: integrating patients into their communities is thought to develop self-esteem and social support, providing a holistic treatment instead of just prescribing drugs. In turn, the community will also be improved. It would take a hard heart to reject this idea completely; friends and community really are an important element in our lives whether or not we have depression.

One report by the charity Age Concern describes the case of a woman who, having lost her husband to suicide, found solace in volunteering as a befriender and in theatre outings. Another, trapped in a rural community without access to transport, was encouraged to organise a local party. Social prescribing is also deployed in support of community gardening, sports and arts and crafts. Although there is little hard evidence to back this up, strengthening the community links of patients seems likely to have a positive impact on their health.

But there is something missing from this picture. Depression is intimately connected with economic structures. Even when we are well paid we might still have a difficult boss. Target-driven work culture is bad for us, leading to intense and demanding jobs in environments over which we have little control. When we are also short of money our situation gets even worse; unemployment impacts negatively on health, and the effect is more pronounced in countries with weak social security systems. Discrimination impairs our mental well-being.

In their new book The Inner Level, epidemiologists Kate Pickett and Richard Wilkinson make a data-based case, not only that unequal societies are worse to live in but also that inequality erodes trust and leads to anxiety, causing an arms race in competitive consumption. This animus is good for no one; disparities in wealth connect with the prevalence of mental illness, and so depression is linked to a deep economic ordering which volunteering is ill-equipped to address. No bowling league will work for a fairer society and no gardening club can keep your boss off your back.

It’s not that social capital theory is wrong, just incomplete: community networks are an important, perhaps vital, element of our lives. But even combined with medication they are not a truly holistic solution to depression. By emphasising community over political action, social prescribing side-steps the economics of mental illness: a focus on social capital shifts the frame away from the social effects of capitalism. It is economic society that needs a visit to the doctor.

Of course we should not abandon hope in voluntary action. In its more radical guise as social activism it focuses attention on the economic context of depression. In this vein, a charity called Time to Change encourages its members to meet with their bosses, requesting a pledge to tackle mental health stigma in the workplace. Another charity, Mind, works to improve welfare benefits for mental health sufferers, encouraging its members to lobby Parliament. In contrast to much community work, these campaigns put politics at the centre.

In the period since Putnam wrote Bowling Alone, it has become obvious that society cannot realistically be theorised as a civic whole of interlocking groups: there is no ‘honeycomb.’ News reports reflect a world of irreconcilable conflict, from Brexit in the UK to the polarising impact of President Trump in the USA. Yet the fact that we can no longer ignore our divisions might lead us to mount a back-to-front argument againstpoliticising volunteering in this way: in a context of strife, non-political community work could be said to provide a neutral space which opens up a civic domain in which we can come together and leave politics at the door; a place where we might give it all a rest and just concentrate on something fun like bowling.

There is some mileage in this view. It’s true that not everyone wants to talk politics with their neighbours, but all political silence has a cost. After two years of field work, the American Sociologist Nina Eliasoph concluded that volunteers often work to keep their conversations neutral, taking care not to sour the mood at meetings. Yet to disengage on social questions is to accept a type of disempowerment, a self-removal from the scene. For Eliasoph, social activists have something valuable that community workers do not—a willingness to recognise complexity, challenge authority, and relate deeply with each other. To confront political issues is only to recognise social reality.

While a focus on the economics of depression might push some right-leaning volunteers out of the meeting room, single-issue activism can still be reasonably inclusive. In contrast to party membership, which might require the broad embrace of a cluster of divisive policies, social activism hones in on a cause. A single issue can provide a point around which diverse people might coalesce, even when they agree on little else. At best, activists enjoy the community advantages of a cell in Putnam’s honeycomb. They can be tightly bound together as friends, but they also have a critical awareness of cracks in the overall social and political structure.

Social activism can mean leafletting, door knocking and collecting signatures, but it is not necessary to get cold outside in order to change the world. Those that prefer the warm might turn to art. William Morris, the Victorian socialist and designer thought that joy in creativity was nature’s compensation for toil in labour. Depressed in office work, we might still take pleasure in music, dance, film, photography, crafts or ‘craftivism.’ It is even possible to politicise a knitting circle if activists put slogans onto clothes, quilts and samplers, voicing the economics of depression in cross-stitch. Or they might write and blog together, explaining the world in order to change it. What matters is that we do all our work with an awareness of society, politics and economics, combined with a willingness to change all three.

The British Minister for Health should be given credit for being innovative, but it is unrealistic to expect him embrace or encourage social activism. No Minister could prescribe social change on the National Health Service; part of the attraction of Putnam’s theory is precisely its political safety. Policy-makers are responsible for steadying the ship of state not rocking it.

When Brooks Newmark, a former British Minister for Civil Society said recently that charities should “stick to their knitting,” he meant to imply that they should keep out of political and economic issues. But that is the voice of the status quo. In fact, politics is precisely what volunteers should be doing—not least with their needlework.

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  1. PlutoniumKun

    Without wishing to criticise attempts to integrate people into activism, back in the 1990’s I was active in an environmental campaign group in UK Midlands when we noticed a significant increase of people turning up to meetings and events with very obvious mental health issues. It turned out one mental health charity was encouraging its ‘helpers’ to bring clients to open meetings and encouraging them to take part. The problem is, the helpers were basically dropping them off, and then going home, leaving untrained people who thought they were about to engage in some green activism wondering why there were so many obviously disturbed people around – I remember one in particular who was quite intimidating in his behaviour. Nearly everyone involved was sympathetic, but it was clearly unworkable and the charity had to be told bluntly to stop treating us as a free support service.

    But on the other side of things, I was also active in a charity involve in doing practical conservation work (like in the photo above). This was clearly appropriate for people with a variety of mental health issues, and the team leaders were reasonably well trained and willing to deal with this. From what I heard later, it got very good feedback from everyone and was well worthwhile.

    1. perpetualWAR

      There is a big difference between a depressed person who otherwise could be assisted by community organization and a severely mentally ill patient, with schizophrenia, for example.

      At times, I have been severely depressed, but I consider myself “normal” mental healthwise. Whereas, my sibling with schizophrenia would not appear “normal” mental healthwise. My mental health deterioration was linked to massive stress of undergoing continuing aggressive litigation. Which ended, as did my depression.

  2. JEHR

    I use walking as my anti-depressant and it usually works; six mornings a week and about 7 kilometres.

  3. barefoot charley

    From a lifetime of activism, I can testify that more often than not, it’s depressing. Because you usually fail, not that there’s anything wrong with that. And people drawn to, let’s say Earth-FIrst!-style radical political activism, tend toward the misanthropic side of the spectrum, which helps inform their analysis (PETA activists being sterling examples). The most effective and driven enviro-politico activists in my experience don’t play well with others, though associates may help compensate for that. All this makes occasional success the more exhilarating. “Action is the antidote to despair.” But if you’re not despairing yet, you should choose your antidote with caution.

      1. JBird

        No, I have a problem with them too. Often it’s the blasted True Believers of the the Truth that ruins it for everyone. Take an issue. Any issue and there’ll be there on both sides.

  4. Mel

    Would patients get to pick their activism, or would it be prescribed?
    Setting community involvement opposed to political action (“By emphasising community over political action, social prescribing side-steps the economics of mental illness”) seems silly.
    People who get involved with more people, and start to get a feeling for what’s up, are better placed to judge what they want to do next.
    I’m reminded of the local Tea Party group in the early days who thought they would deepen their involvement, and wound up getting used as human flip-chart easels in a demonstration far away.

  5. Bill Carson

    This is really no secret, is it? If you find yourself depressed, you need to get out of bed or off the couch, take a shower, shave, and put on clean clothes, and get out of the house. Move your body. Expose yourself to fresh air and sunlight. Find a hobby! To start with, think back about what you used to enjoy doing, and rekindle your interest in that. Find a group with a common interest and go do something together. Whether it is church or a music ensemble, library, animal shelter, a local political organization, or non-profit group whose aims you would like to promote—go get involved.

    And pretty soon, you’ll feel better. Perhaps without meds or therapy or navel-gazing. (Though there’s nothing wrong with seeking professional help if you need it.)

    Does our economic system perpetuate mental health issues? Certainly it does. There is nothing wrong with you. Your depression and anxiety are normal reactions to the awfulness of our culture. But don’t allow yourself to wallow in self-pity.

    1. Anon

      That works – until it doesn’t. Then you need some professional help and maybe some meds. There’s a difference between the blues and serious, clinical depression where you are about to do away with yourself at a minute’s notice.

      Posting as Anon for obvious reasons.

    2. JBird

      Good advice for most. I wish that was true for everyone. However, illnesses are usually more tenaciously pernicious or insidiously destructive monsters.

      It can be a problem for the seriously depressed to actually do anything. That what depression often does to a person. Indeed, the very thing that often can help them the most, social contact, is often the very thing first that they withdraw from and therefore often don’t have. It often feeds on itself. Worse, a person can be unawares that they are suffering from depression. You might recognize it, but not them, which is kind of strange.

      Then again, mental illnesses can often be described as malfunctions of perception. Which is why the severely ill often do not do what is needed. That’s why you will see schizophrenics, bipolar, and others not taking their meds or even the mildly depressed not talking those walks.

  6. Lord Koos

    I have never heard that becoming an activist was some kind of antidote to depression, that’s news to me. I have heard that doing charity work or directly helping other people can be helpful. This makes sense as it puts the depressed person into action, forces them to become involved with others, and may help to relieve the sense of being a victim, etc since they are now doing the helping as opposed to receiving help. Connecting with other people is a biggie since people can easily feel isolated, especially in cities.

  7. French75

    I get what John is saying: economic standing and class relations play a big role in self-image, and likely contribute to “environmental” (by which I mean non-genetic causes of depression; and increased social activism to improve equality and rework cultural norms could do a great deal to lower the incidence of depression.

    That said, those who are clinically depressed should not be considered as a labor pool for social activism; and their medical treatment should not be linked to any desired social changes.

    But even combined with medication they are not a truly holistic solution to depression. By emphasising community over political action, social prescribing side-steps the economics of mental illness

    I really have to push back against this. The economics of mental illness is an epidemiological issue that operates at the level of populations. It does not operate directly at a personal level: the class divide in an individual’s community compared to the surround, perceived opportunities for personal growth, and so on. Political activism also is aimed at altering population-level statistics; but for someone actually with depression, it is very unclear to me how it helps them. In fact, enrolling oneself in an activity where

    1) The focus is on the negative aspects of life and society
    2) The outlook is divisive (there is an “other side” – which may well include your neighbors)
    3) The general tone can be combative

    would seem to contravene the principals of community integration.

    1. jrs

      if one is really suffering from various economic deprivations and despair over them (like say unemployment or poverty if there is awareness of it) then #1 is irrelevant and #2 is probably too. Because people suffering this often Already Know that society has negative aspects and is divided – and it can’t really be repressed entirely with positive thinking.

      But it doesn’t mean activism cures a depression either.

  8. knowbuddhau

    >>> “What matters is that we do all our work with an awareness of society, politics and economics, combined with a willingness to change all three.”

    Joyful participation in the sorrows of the world, however you put it, sounds good to me. I go to ground once in a while. The hardest part is getting through that initial inertia.

    Of course it depends on how it’s done, thanks, Captains Obvious.

    Actually, wouldn’t that be, “change all *four,” to include one’s self?

  9. Newton Finn

    We are immersed in and intertwined with a cutthroat socio-economic system, globally entrenched and hellbent on killing both people and planet to further enrich and empower a sliver of elite sociopaths. If we’re not depressed on some level, we’ve chosen to remain in denial and to live in Lalaland.

    THAT’S the baseline for any kind of meaningful discussion about the issue of public mental health, a quite different animal than specific illnesses like schizophrenia which have always plagued unfortunate individuals in every society. So deeply has neoliberalism infected our perception and cognition that even when we try to speak about measures to improve the mental health of the public, we reflexively resort to using neoliberal terms and categories such as “social capital,” as degraded a reference to human interaction as is “human resources” for working men and women.

    Only when we free our minds (and hearts) from the insidious clutches of the reductionist death drive embedded in neoliberalism will we find the vision to imagine a better, more beautiful world, and also find the energy and resolve to begin to build one. As much as the word is out-of-fashion and routinely (and often, justifiably) derided, the antidote to the neoliberal sickness is essentially “religious.”

    All of humanity’s great religious traditions offer avenues of such liberation and renewal, if the wheat in these traditions is separated from the chaff. Otherwise, religion, too, is only a part (and a major part) of the problem. Here’s just one example of the kind of separation of wheat from chaff that I believe to be humanity’s only hope to overcome the omnipresent evil we have ourselves created:

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