Healthcare systems in the United States place the onus of healing on individuals and focus on self-optimization in service of inherently violent capitalism.
TW: mentions of suicide, depression, anxiety, PTSD, and forced institutionalization
Every suicide prevention day, week, or month, I once conveyed the same message, regurgitating advice that, at the height of my battle with depression, had been readily proffered: “Reach out.” On Facebook and Instagram, on a domain that I purchased for my writing, to friends and family. Reach out.
I would share a highly personalized experience of my depression and later PTSD, my attempted suicide, and reassurance that it does become better. That if people were to embark on a journey of self-care, through counseling, therapy, or medication, their efforts would reach fruition.
But, when I adhered to my own advice, I always seemed to fail. And fail again. I reached out. I attended therapy. I started medication. I attempted to disclose my diagnosis to workplace after workplace, in hope that I would be accommodated in my debilitating anxiety and panic. I continued to commit to X or Y task, because external measures of productivity demanded that I do so, and then I would fail to meet said commitment. At each turn, I only felt overwhelmed, rarely did I feel assured in my capacity to transcend mental illness.
Central to neoliberalism is individualism. Testimonials are inherently individualistic; they speak to an individual’s experience. At first, my testimonials (from social media posts to essays) acted as a means to recover a sense of control and to place trust in my subjectivity after extensive childhood trauma. But, I also understood that testimonials like mine — which utilized a depoliticized “I” and proffered triggering detail, exclusively through the lens of unexamined anger, rage, and self-destruction — existed comfortably in the confines of the capitalist system. Especially because my narrative would culminate in a journey of healing and recovery independent of histories of oppressions and the material realities that they create for people diagnosed with mental illness.
My narrative(s) would be grounded in self-care and would end in my return to “self-optimization” or readiness to function again — this time, properly — in capitalism.
In Radical Care: Survival Strategies for Uncertain Times, Hi’ilei Julia Kawehipuaakahaopulani Hobart and Tamara Kneese write, “Self-care is thus popularly associated with self-optimization, or a way of preparing individuals for increased productivity in demanding workplaces, when, in reality, things like chronic illness are incompatible with capitalist productivity and even visible forms of activism: it is difficult to join street protests if you are a caretaker, suffer from depression or anxiety, or cannot get out [of] bed.”
Plainly, I did not have the capacity to see beyond myself, in my experience of mental illness. I wallowed in self-alienation. I could not see that the struggle for many (including myself) is not “reaching out,” but the struggle is inextricably tied to the system that we occupy — a system that pathologizes our condition, and a system that is not designed to serve the common good.
When I was diagnosed with depression and later PTSD, I was introduced to a system of care that placed the responsibility of my healing in my hands, and my hands only — as if I am the arbiter of all the circumstances that would unfold in and influence my life.
Integral to this system of care is therapy. My first experiences of western therapy acted as if I existed in a vacuum, separable from the circumstances that I inhabited. The objective of each session had been self-optimization. Not for myself, but to function better in the neoliberal university or the future workplace. My sense of alienation only strengthened after therapy. I could not explain why it did not work; but I knew that it did not.
In On Mental Health and Psychotherapy in Late Capitalism, Richard Lichtman describes therapy as a “mode of conformity to the prevailing system of corporate and state domination.”
“There is no designation in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the incapacity of individuals to recognize the malevolence of the system that exploits their labor, then turns it back upon themselves as alienated but ‘natural’ domination,” he explains.
Lichtman continues, “Therapy reinforces the basic assumptions of capitalist culture in regard to its definition of the self and its boundaries, the system of its needs and the material relations it establishes among social members. Its gravitational pull is insular, ‘deeper’ within the individual, personal relationship, or family. These considerations explain one of the major functional paradoxes of therapy; its capacity to ameliorate the conditions of individuals or of small groups while simultaneously strengthening the larger system of social control.”
My attempted suicide — the one that resulted in my institutionalization — took place three years after my first session of therapy. My institutionalization demonstrated the carceral response to mental health undertaken by psychiatric care facilities.
I was transferred to an emergency unit, where I was told that “the State of Colorado” is responsible for my forced institutionalization. Once I arrived at the psychiatric ward, my phone was confiscated. I could not leave the ward, and outdoor time consisted of 30 minutes on a heavily fenced balcony. The speakers that visited to motivate us — us, the pathologies of late capitalism — were people who could function (i.e. work) after the onset of X or Y illness. After one such speaker, my body started to twitch. I hurriedly left the room, only to faint and slam my head onto the door handle. As the nurses inserted IV or attempted to take a blood test, I protested. I knew that each pill, each injection only cost more money. The bill amounted to $6,000 for a four-day stay, itemized by pill, injection, and meal.
My present understanding of my mental health in relation to capitalism only occurred once I left the United States for Europe.
Before Europe, I relocated to New York City, where I worked a desk job at a local nonprofit. I decided that I would disclose my mental health to my employer because I am not the “normal” worker. One week after signing my contract, I disclosed my PTSD. They feigned understanding, but eventually, they grew increasingly frustrated at my inability to fulfill the eight-hour workday. Their sole accommodation remained a two-hour lunch break each Thursday when I would rush to the Upper East Side to see a therapist for 45 minutes. I would have triggering conversations and revelations, only to return again to my desk, to function like “normal.”
But, there had been an unspoken caveat: if I am provided two hours to attend therapy on Thursday (two hours that I would work to cover past 5 PM), then I could not show signs of neurodivergence elsewhere. The exasperation that I would see on my supervisor’s face, if I observed an onset of a panic attack and notified her, caused panic in return — I dreaded work.
I left New York City to live in France, in order to move closer to my then partner and also because I had burned out. I waitressed and took French lessons at the local university, but even as I occupied a service position, I became introduced to affordable health care. Buying my medicine or attending psychiatry, as a non-citizen, did not break my bank. I was provided a housing allowance that reduced my rent in half because I had been a student. I was offered subsidized lunches, again as a student, where I paid 3 euros for an entree, a main meal, and a dessert as well as coffee. I paid 15 euros for unlimited, monthly transportation (in comparison to $120 in New York City). Out of the 800 euros that I made monthly, the fear of more and more debt did not loom as it had in the United States.
I was then accepted to attend university in Finland, where I currently receive subsidised housing, meals, and transportation. I have access to universal health care; I was reminded by a senior student that I did not have to worry about calling an ambulance because the service is free. When a concerned friend had called 911 on me in New York City, I received a bill of $1600 to compensate the emergency personnel that arrived and stayed for 45 minutes, which was reduced to $800 with insurance.
The university here accommodates me and my PTSD as well. Once I had a severe depressive episode around the time of an examination, and I was informed that I have three retakes per final exam. I also work as an intern, and I am paid a hefty salary for a three-month contract, which includes 6 days that I am required to take off for rest or leisure.
My material reality shifted drastically from the United States to Europe. The system that I started to occupy was intended to support my basic needs — to a certain extent. The welfare systems of Europe are predicated on plundered wealth from colonization. And, my ability to relocate also could not have been possible, were it not for my U.S. passport and the financial stability that I come from. Even the safety guards that I now experience would not be so easily extended if I did not speak English, did not have degrees from American universities, or more generally, did not fit the criteria of a “skilled” laborer.
To be clear: I was able to leave the United States, so as to salvage my mental health. But, for many, the material reality created by late capitalism can not afford an escape; in order to renounce American citizenship, you have to pay $2,350. The United States increased the fee from $400 in March 2020.
The experience of the past two years, outside of the United States, thus also shifted my narrative of self-care to a narrative of radical care. I did not exist as a self disconnected from “particular histories and present situations of violence and vulnerability” but as a self grounded firmly in said histories and situations. So it is not enough to “reach out” in order to prevent suicide. The history and the present of the United States is violent, and it is not easy nor possible for the persons that exist outside of or violate “the structures of white, middle class respectability” to survive its capitalist demands.
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