When we hear about ‘mental health’ in popular culture, white, wealthy, ‘recovered’ voices are often at the forefront. But for years, outside of the mainstream, there has been political resistance to this representation. Take the anti-psychiatry and psychiatric survivor movements of the 60s and 70s – two campaigns (of many) that have attempted to connect the dots between our political, economic and social system, and individual suffering. They’ve also raised questions: do diagnoses always help, or can they actually be a hindrance? And how much of our mental wellbeing is driven by widespread societal suffering?

Writer Micha Frazer-Carroll continues to explore these complexities in her debut book, Mad World. Linking movements such as disability justice and abolitionism, it draws a thread between the historical context of psychiatry, diagnosis and resistance, with Frazer-Carroll asking us to think twice about what we think we know about mental health.

Mad World is an accessible and in-depth tool for thinking radically and politically about mental health in the 21st century. Here, we speak to Frazer-Carroll about the limits of ‘raising awareness’, the issues with prevailing attitudes towards diagnosis, and the ways in which mental health support could get better for us all. 

In the book you write about us being in the ‘age of awareness’. Why do the ‘raise awareness’ and ‘mental health doesn’t discriminate’ campaigns that we see in mainstream media, online and popular culture so often fail to have any real impact? 

Micha Frazer-Carroll: ‘Awareness’ is an unambitious political end-goal for a few reasons. Firstly: awareness of what? The information circulated in ‘awareness’ narratives often uncritically props up neoliberal ideology. Neoliberalism supports the privatisation of major businesses, cuts to state welfare, and an emphasis on ‘individual responsibility’.

That ‘individual responsibility’ idea is present in so many messages from awareness campaigns: the idea that it is our duty to reach out to loved ones and services for help; the suggestion that mental health support should come in the form of a ‘service’ at all; the emphasis on individual tools like therapy, meds, self-help, mindfulness and apps to manage our suffering; and the suggestion that mental distress or illness is best thought of as an objective biological dysfunction in an individual’s brain. These ideas frame each of us as individual actors, who bear the responsibility of bringing our bodies and minds back in line with the demands of the market. This will never bring us real liberation or healing.

‘Awareness’ also takes no account of the structures that harm us. It suggests that stigma and oppression mainly stem from inadequate knowledge, when they really come from economic, political and state systems. It undervalues how knowledgeable what we sometimes call ‘mad’ or ‘mentally ill’ people actually are. Many people with experience of mental distress know, for example, what services are available to them – as Hannah Jane Parkinson wrote in a 2018 essay: “[It is] infuriating to come home from a secure hospital, suicidal, to a bunch of celebrity awareness-raising selfies and thousands of people saying that all you need to do is ask for help – when you’ve been asking for help and not getting it.” One million others sit on a mental health waiting list. So ‘awareness’ is clearly not the start and end of the problem here. 

“We should also remember that so much of what we call ‘madness’ or ‘mental illness’ is actually just behaviour that does not lend itself well to the capitalist economic system” – Micha Frazer-Carroll

How do age-old stereotypes and biases shape who is labelled and who is listened to?

Micha Frazer-Carroll: You see this play out in lots of complex ways that need untangling. Black people are five times as likely to be detained under the Mental Health Act than our white counterparts. But we are less likely to make contact with services before this point – for many reasons, including our historical treatment by medical and state systems. Literature from the 1970s also discusses how Black people would be more likely to be given electroconvulsive therapy and tranquilisers, while white people would be offered psychotherapy.

These trends are classed too. If you are rich, you will have greater and earlier opportunities to access whatever kinds of therapies or healing practices you prefer, meanwhile, poorer people are limited to options on the NHS (usually meds and CBT), and have to sit on waiting lists.

Gender also plays a huge role in experiences in the system. About 75 per cent of people diagnosed with borderline personality disorder (BPD), a diagnosis that often carries horrible outcomes for people within the mental health system, are women. Trans people have historically been pathologised within psychiatry, and they still usually have to get a diagnosis of gender dysphoria to access gender-affirming care. You can, however, be denied this diagnosis or care if you have a diagnosis of autism or other psychiatric disabilities. 

Our suffering, our diagnosis and our treatment are far from objective or apolitical. If you are a marginalised person, your experience of all three of these things is likely going to be worse.

You write about the polarising ways in which diagnosis can shape a life and determine how we are treated and if we are cared for, yet so much of our current perception of mental health clings to diagnosis. How can diagnosis be made into something that is empowering for all?

Micha Frazer-Carroll: When you tell people in casual conversation that you are writing a book on mental health, the first thing they often want to talk about is diagnosis. I think it occupies a really central position in the cultural imagination right now. Lots of people I speak to seem to be coming to a diagnosis as a means of understanding their experience of the world, or they are shaking off a diagnosis to achieve the same thing. And lots of other people bemoan teenagers diagnosing themselves on TikTok – this idea that ‘everyone has a label now’. 

In the book, I try to resist the false binary of ‘diagnosis – good or bad?’, and rather, look at the role of power. Most of us really have very little say in the diagnoses we get, even though we all carry a lot of self-knowledge about our bodies and minds. You see the impacts of this a lot when it comes to mental health and neurodivergence: people fighting for years for their autism or ADHD diagnosis, or trying to get an eating disorder diagnosis despite their gender, race or BMI. 

To make diagnosis something ‘empowering’, the first step is to completely break it apart and acknowledge all of its potential different and conflicting functions. Diagnosis can give you access to community, or cut you off from community. It can give you access to benefits, or it can bar you from income through employment. It could get you your meds, or see you denied your meds. It can feel like a validating description of our experiences, or a horribly invalidating one. It can help us come together and organise, or fracture solidarity. I want us to take diagnosis out of the hands of the state, and put the power back into the hands of those most affected. This world would be one where diagnosis was no longer a means of state gatekeeping and control. It sounds abstract, but it exists in pockets today – for example, trans communities are already showing us how self-identification and informed consent models of ‘DIY healthcare’ can look outside of state systems. The possibilities for describing ourselves and finding paths to healing are really endless. But acknowledging this requires a kind of mad, utopian and abolitionist thinking.

You write that mental health needs to be politicised. How could this change our current relationship with mental health?

Micha Frazer-Carroll: If we push our thinking about mental health to be as political as possible, it becomes easier to link it up with other liberation struggles, and to create a world where we all suffer less. Mental health means border abolition and a free Palestine. It means the end of the capitalist economic system. It means the abolition of all forms of incarceration and punishment. It means trans liberation. It means disability justice. It means clean air and water for everyone. It means intergenerational healing justice. These things are all inextricably intertwined with the thing we call ‘mental health’.

But we should also remember that so much of what we call ‘madness’ or ‘mental illness’ is actually just behaviour that does not lend itself well to the capitalist economic system. Politicising mental health means questioning why we call certain things madness or mental illness, and allowing people to make their own minds up about their experiences of the world. For example, some people who hear voices find it to be an enjoyable, comforting or deeply spiritual experience. That’s only a bad thing for our economic system, because hearing voices often makes it harder to ‘function’ as a wage labourer. So, when we think politically about mental health, we rapidly realise that there are far more ways of existing and flourishing than we currently think. That’s a really exciting prospect to me – the ways that we could all be mad and weird and neurodivergent in a world that didn’t value us according to our exploitability.

It’s hard to imagine a world beyond the bleak form of mental health treatment we have in the UK now. What were your favourite examples of alternatives and resistance when researching?

Micha Frazer-Carroll: In any liberated future, care will be wide-ranging, abundant, flexible, ever-evolving, and tailored to hyperlocal context and also to the individual. Trieste, a small city in the northeast of Italy, is a famous and important example of a mental health system that does not rely on restraint, coercion and incarceration. In Trieste, they aim to address mental distress before crisis point, and also try to create an environment free from entrenched power dynamics – for example, staff do not wear uniforms. You can find similar approaches at non-medical ‘crisis houses’ in the UK and beyond. 

Peer support initiatives like the Hearing Voices Network also show us the importance of mad people caring for one another, and pioneering their own [non pathological] approaches. For example, the network conceptualises voice-hearing as something that can be neutral, or, as I mentioned earlier, positive. Groups help people live with and engage in dialogue with their voices, rather than treating them as a symptom to be forcibly eradicated, as traditional psychiatry does. 

We should also be looking to grassroots and community-run alternatives that have sprung up much more recently and are adapting to our current political climate. Project LETS in the US, and Campaign for Psych Abolition in the UK, have explicitly linked up their work and politics with that of the prison abolitionist movement. Psych abolitionist groups like these have a similar emphasis on mutual aid and transformative justice, and are developing really complex and visionary tools that are actually robust enough to respond to distress, madness and crisis (like Mad Maps).

One really significant ‘alternative’ to our current system is also the creation of a world where far fewer people get to crisis point in the first place. That’s a far bigger project, but it’s one that we must all keep sketching and dreaming towards, because we can’t afford not to.


Mad World is published by Pluto Press and available to preorder now.

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