Mad World w/ Micha Frazer-Carroll (08/31/23)
Bea speaks with Micha Frazer-Carroll about her new book Mad World: The Politics of Mental Health.
Micha Frazer-Carroll 0:00
I think when we expand our approach and kind of let go of the certainties care could be everything. You know what if care is not just this drug or that therapy, what if care could be anything and everything? And what if healing could be everything? And not this question of you know, does mental health care come from this institution or that institution or the community? But what if it could look many many different possible ways?
[ Intro music ]
Beatrice Adler-Bolton 0:51
Welcome to the Death Panel. Patrons thank you so much for supporting the show. We couldn't do any of this without you. If you'd like to support the show become a patron at patreon.com/deathpanelpod to get access to our second weekly bonus episode, and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore and preorder our co-host Jules Gill-Peterson's new book, coming January from Verso, called A Short History of Trans Misogyny, or request them at your local library and follow us @deathpanel_. I am so so excited to introduce our guest today. Misha Frazer-Carroll is an author and journalist who is joining us today to talk about her book called Mad World: The Politics of Mental Health, which was just published by Pluto Press. Micha, welcome to the Death Panel. It is so nice to have you on the show.
Micha Frazer-Carroll 1:49
So nice to be here. Thank you for having me.
Beatrice Adler-Bolton 1:51
So I guess you know, full disclosure, I endorsed Micha's book. There's a blurb from me on the back cover, I completely stand by what I said. And it was an honor to get to read you know, this book early. I read it in March, I've reread it twice since. It's a really urgent book, it's a great introduction to thinking through how mental health, mental illness, madness, etc, can be politicized and also how that fits into a disability justice or a health communist framework. And, Micha, in the book, you talk a lot about the need to sort of embrace the messy, complicated, unruly vulnerability, of uncertainty and of our collective interdependence. It's a really wonderful text. And it has some really great concise histories and talks through the nuance with so much care. So first off, I just want to say, congrats, and I am so so fucking glad that Mad World is out in the world, and that we're getting a chance to finally meet if only over Zoom.
Micha Frazer-Carroll 2:46
Oh, my God, thank you so much. Yeah. And you know, I was such a fan of Health Communism. I'm such a fan of the podcast, like, I'm feeling equally excited about this conversation. Yeah, we've got a lot of overlap.
Beatrice Adler-Bolton 2:57
Mutual appreciation society. Absolutely. [ both laughing ]. So anyways, let's dive right in. In Mad World, you write that the book's goal is to carve out a radical approach to mental health that specifically names the extractive dynamics of capitalism, but that doesn't reproduce some of those sort of totalizing mistakes of past left understandings of this, like the idea that if capitalism were gone, no one would be sick anymore, or that mental illness is not real, at cetera, et cetera. But this book is also you know, resisting liberal frames, the idea that awareness fights stigma; that access to care is cover for, really, austerity. It's a very messy landscape. And importantly, I think, you know, there's no one dominant theory of madness, mental health or mental illness. And as you really argue, one dominant theory or explanation is absolutely not necessary. And we're gonna talk about all this today. But just to sort of start, can you talk about, you know, why you wrote this book, and what you hope this book can offer to readers?
Micha Frazer-Carroll 4:03
Definitely. So I started talking to the publisher, my publisher, Pluto Press, in 2019, about this book, and I feel like during that period, it was kind of just at the peak, or maybe just coming down from the peak of these kind of liberal conversations about mental health "awareness." And I feel like, you know, there was all of this kind of discourse about how we need to all speak out, break the stigma reach out to services. And I think, you know, you see a similar thing happening at the same time in the mainstream publishing climate, you know, this dominance of memoirs, of individual stories of struggle but crucially of struggle and then recovery. And this kind of, you know, people only being able to speak from the kind of podium of "sanity," "rationality," "recovery," about kind of their previous struggles or their previous suffering. And while I don't think there's necessarily anything straightforwardly wrong with individual stories, you know, individual narratives. I was finding the dominance and kind of saturation of these narratives, quite frustrating. Like I just felt that there wasn't much discussion of anything political, you know, how marginalization and oppression interact with who experiences distress and suffering. And then I think there's kind of this dual function of a second thing I was trying to do, which, as you name is like, kind of trying to speak to the left. And kind of responding to how, you know, obviously, "the left" is a large and sprawling kind of thing. But responding to how some of the conversations I was seeing about mental health there. And I felt that on the left, you know, there was more discussion of, you know, I guess what you call disproportionality. That Black people are more likely to be, for example, diagnosed with schizophrenia, you know, why are so many women diagnosed with depression and anxiety, and kind of, you know, thinking about who disproportionately experiences distress and naming that as political. But I was still kind of frustrated with those conversations, too, because I think I was finding that there wasn't much discussion of actually, when we talk about mental health or madness, you know, why do we take this, this kind of concept at face value? And I wanted to ask kind of, what is this thing, this kind of innocuous thing that we call "mental health" or "mental illness?" How did it come to be? How is it shaped, shaped as the category that it is? And could that be different in a different world? And I think this kind of, you know, is related to the fact that I was very lucky in my studies, to kind of come across the anti-psychiatry movement and the psychiatric survivor movement. And that's something I also learned about through organizing around mental health. But I felt that these movements in a lot of ways were really forgotten in kind of political spaces on the left. And I think that that was related to this issue that I named of people not necessarily questioning, what is this thing that we call mental illness? And also questioning, you know, how do we, you know, quote, "treat it?" Again, should we take these treatments at face value, kind of what is their function? And then I think there's kind of, there's maybe a third kind of secret function.
Beatrice Adler-Bolton 7:25
[ laughing ] Oh, I love it.
Micha Frazer-Carroll 7:27
I think those are the two main ones. But I think there is this third secret function, which is also kind of pushing beyond and responding to people who are maybe deeper in these conversations, you know, people who are familiar with anti-psychiatry, familiar with leftist critiques of, you know, pathologization, and medicalization. I think there's a third function of kind of trying to question also some of the people who are doing the questioning, you know, and saying, I'm sure we'll get into this, but some of these arguments like, you know, "mental illness isn't real," "it's all capitalism," you know, I was seeing some of this coming up in some leftist spaces. And I'm trying to respond to that, as well, I think. But that's a kind of quieter function that's moving through the book.
Beatrice Adler-Bolton 8:12
Well, and I think the book accomplishes this beautifully. And perhaps for clarification, because you and I have a lot of shared context on this. But listeners might not necessarily have the same context. You know, there are a lot of interchangeable words that can be used for what we're talking about today. Mental health, mental illness, "mental dysfunction," "degeneracy," even. "Madness," right? You know, in terms of this is a political, social and medical category, depending on the time, the moment in history, you know, the particular context, the identity of the person with the label, you know, these words change, and their meanings change. And it's very, very highly context dependent. So as these words have sort of evolved and shifted and changed and become sort of interchangeable. You know, when we talk about the category as a whole today, we'll probably use the word "madness" most often, or something like mental illness or mental health. You know, mental illness and mental health are more like the terms that are most popular right now, that are most commonly recognized. But using the term "madness" as a catchall rather than words that are tied into systems like our existing health care system or medical care system, or things like the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, you know, these like individual diagnoses. You know "madness," instead, deliberately sort of is appropriated by movements for psychiatric liberation, because it's kind of from without. It's like an older term and a different way of referring to these things that's no longer connected to the systems of pathologization that we're currently working with. So you know, it's it's been sort of a way to kind of challenge and disrupt the dominant psychiatric perspective, the idea is to kind of build solidarity across people who are divided into different groups by diagnostic category. So really, you know, the idea is to sort of undermine the medical framework that categorizes people as having an illness and disorder, but not to deny that they're real. And to also point to the fact that folks in need and want more than psychiatry and medicalization can offer. So, you know, I think just to sort of lay that out for people, you know, this perspective, you know, as Micha is saying, we're talking about something that doesn't negate the need for support. This doesn't negate the need for medication, or anything like that. It's more of a "yes, and" perspective that questions the idea that psychiatry and medicalization should be the sole authority in addressing mental and emotional struggle. And it's also an acknowledgment that sometimes things like mutual aid and peer support might be much better ways of providing more meaningful help and care than psychiatry can offer in times of distress and crisis. So to sort of preface this, you know, I'm going to ask you an impossible question here. [ both laughing ]. So, you know, Micha, we're going to talk about some of the ways that like, madness is talked about. But what is madness? If you were to describe it. Like, we're so rarely given the chance to sort of lay this out and not just react to these prior framings, that we're trying to critique and reframe, but sort of, you know, in a more positivist sense, can you sort of describe in the best way that you can possible sort of what a way to think about this as a category is, what a way to think about, you know, someone's potential membership in the category? And also what it means out in the world?
Micha Frazer-Carroll 11:36
Yeah, wild question.
Beatrice Adler-Bolton 11:38
Sorry. [ laughs ]
Micha Frazer-Carroll 11:39
No, but I think it's a good one. And I think that, like you say, I am—I really, throughout the book, I really, you know, went through the language question that you name of madness, mental illness, mental distress, suffering, psychosocial disability disorder, mental health problems, like all of these words, I think, are already gesturing towards the fact that this is a very leaky and unstable category, that it's a moving target. And that when we're talking about madness, or mental illness, or whichever these words we choose to use to discuss it, we're talking about a lot of different overlapping things. And it's funny because I first named the introduction of this book, "What Is Mental Health?" Which was ambitious. And I felt that it was a question that I was never really able to confidently answer with a sense of finality. But I think the kind of working definition of how I might describe it is, I guess: behaviors that are disruptive to capital accumulation, or to kind of the dominant societal order that we have, that seem to have some rooting in the mind, and have been assigned as things that the mental health industrial complex should attend to. And obviously, there's a huge overlap here, with suffering, you know, many of these things that fall into this category are experiences that are characterized by suffering. But I actually argue that, you know, the definition of mental health that we're working with, in our current society doesn't use suffering as a precursor, you know? There might be many people who are having experiences that they are okay with, or they are happy with, or that, you know, they believe are just how they are. But they are still pathologized as mental illness, or madness, because of this disruptive function and how it's been constructed. But yeah, as you can see, like through that definition, that is so leaky, you know, the, the decision about which behaviors fall under, for example, the mental health industrial complex, versus, for example, the criminal punishment system, that in itself is quite arbitrary. And we see that there's a lot of overlap in their behaviors that are sorted into each system. And then you've also got, you know, overlap with, for example, the cultural practices of racialized people that are seen, as you know—we have these questions often that come up about, you know, is—is this madness? Or is this sanity? Is this just ordinary distress? Or is this illness? And I guess, as well, that's the working definition that I have I, you know, I kind of want to emphasize that there aren't hard bounds around it. It's not something that we can kind of isolate and say, "this is it," "this is what it is."
Beatrice Adler-Bolton 14:33
Absolutely. And I think that refusal of hard boundaries is actually so important to understanding the definition here, because one thing that you I think articulate so well in the book is how psychiatry has built its sort of professional clout throughout history by asserting various truths about this category of people who get labeled with whatever these labels are, as they have changed over time. But part of the kind of authority and subjection of people who are mad or who were given labels of, you know, diagnoses that fall under the umbrella of psychiatric control, is the assertion of being able to provide clarity and being able to be the person who can sort of "predict" the behavior, standardize the behavior, standardize the treatment and impose a kind of standard duration of expected recovery, because as you're saying, so much of how these, you know, categories actually operate in the world—and ultimately, it's important to look at that, because that shows us, you know, what the experience is like to be labeled as such, and to live under capitalism, you know, with these behaviors or circumstances or whatever. Like, the kind of refusal to engage with knowing and with the boundaries, and with being sure, is really important towards, I think, a liberatory understanding of how to approach this as a political category. Because, you know, part of, you know, the things that we're reacting against, these explanations and these sort of totalizing, very conflicting frameworks for what mental illness, mental health, madness, whatever is, part of their power is in claiming to be so sure that it's definitely, you know, a "deviance," it's definitely like a "chemical imbalance," it's definitely something that can be corrected by this therapy. It's definitely the product of capitalism alone. It's definitely like a broken leg or cancer, you know, it's part of what, you know, we're trying to resist here is the claim to certainty, right?
Micha Frazer-Carroll 16:39
Exactly, yeah. And I think this—I call it kind of like the production line approach—
Beatrice Adler-Bolton 16:44
Mm.
Micha Frazer-Carroll 16:45
Psychiatry, I feel like, has a production line approach to mental health in that it does aim to standardize and create very fast, efficient, effective frameworks for understanding and pinpointing what it is, which I think is also you know, kind of underpinned by quite a colonial enlightenment mindset as well. But also certainty about how we respond to it, like you say, "this is the diagnosis" and you know, a diagnosis has some kind of clear treatment outcomes that are the paths that you must take, and they will bring you towards recovery. I think it really hinges on this idea of certainty. And I think that psychiatry, you know, much like the rest of the medical industrial complex has this claim—it claims to reveal inherent truths, right? It—you know, it doesn't say, "here's one subjective way of thinking about things." It claims to have authority on truth through this kind of process of standardization and clarity and sureness. And I argue that, you know, I think a lot of arguments on the left will say, you know, it's the biological approach, or the biopsychiatric approach, which obviously, kind of had this resurgence in 1980. It's this that is the most kind of insidious thing about psychiatry. But I kind of tried to complicate that a bit. And also argue that I think, actually, it is this quest, this relentless quest for certainty, that I think is actually also so harmful about psychiatry. And you see it in the biopsychiatric approach, that "we will find biomarkers." You know, we will find the blood test or the brain scan that finally, we can point towards it on a chart and kind of say, this is what it is. But I argue that you can also find this quest for certainty in arguments that are on the face of it kind of more political or liberatory arguments. You know, for example, like we've mentioned, this idea that "mental illness isn't real, it's all just capitalism." It's all social, it's all ordinary distress. I think that this in itself, like, this can also be really insidious, because then you also, you run the risk of—you can lapse into moral arguments, right? That it's "moral failure," or that, you know, we see different arguments in kind of psychiatry, when it was more psychoanalytically informed that are around, you know, mental illness is about—it was, you know, "the failure of the mother to provide the right home environment" or things like this. So I kind of argue that I'm not so interested in the question of what it actually is. I think that that can be a really important question for us, kind of as individuals, I think it can be important for you know, how we think about and politicize our own experiences in the world. But I actually think that this kind of relentless quest for the answer and kind of, you know, again, that's tied to the scientific kind of quest for "the cure," "the truth," the, you know, the blood test. I kind of think that this quest is not really what it's about, and I think that it's still possible to politicize mental health and to organize around it without having this kind of ontological argument of what it really is,
Beatrice Adler-Bolton 20:04
Absolutely. And I mean, obviously, I'm biased, this is something that Artie and I write about at length throughout Health Communism, but I thought you just did such a beautiful job articulating the stakes here, which is ultimately like, it actually doesn't matter what it is, right? And to waste the time on sort of sitting around and the quest for the truth here, you know, that's ultimately an impulse that is both antisolidaristic and also, frankly, a fucking waste of time. [ Micha laughs ]. I mean, to sit around and think, like, "why is someone doing this?" You know, and sort of like the—let's take, for example, the idea that "if capitalism were gone tomorrow, mental illness would not exist." That framework of thinking, right, that kind of magical solutionism, it's very The Secret, it's like putting something up on a vision board that's a really complicated problem, and making a wish on it to avoid sort of thinking through how you actually accomplish it. And you talk about how it's not just ideas like "when capitalism ends, mental illness is gone" that operate this way. It's also the idea of, like, asylum-based care, or the total institution, or even just the biopsychosocial approach to biopsychiatry and pharmaceuticals. And you know, whether or not it's that approach, that's the problem or not, there's a tendency to sort of point to one thing and say, aha, if not for, you know, but for x, y, z, we wouldn't have to address this difficult problem. And all that does is waste time that could be, you know, allocated to actually providing peer support. To actually thinking through these problems. And they're difficult things to conceptualize. Like, I understand why there's a tendency to sort of look for a silver bullet, but that sort of imposition of cyclicality and a simple solution, standardization, you know, this is productive of violence and suffering in and of itself. And that's why it's so important to resist, like, I love the way you frame it, you know, the quest for kind of "truth" as a quest for the "cure," in and of itself.
Micha Frazer-Carroll 22:15
Definitely. And I think the book is, in many ways, kind of an argument for mess in how we understand it, in embracing messiness.
Beatrice Adler-Bolton 22:24
In a beautiful way, too, yeah.
Micha Frazer-Carroll 22:26
And not being—yeah, not being afraid to, like you say, to accept, maybe there isn't one clear solution to this. As we've already named, like, the category of madness, or mental illness in itself is so messy, it's so many different overlapping experiences. You know, why one person might experience a crisis is completely different to, you know, the circumstances that would lead someone else to crisis. How could we expect something that's so personal and so different to have blanket solutions for how we approach it? And I think that, yeah, I kind of want to call back to the asylum system, especially in articulating this, you know, the messiness, and the fact that there's not one clear approach. If you look at the history of the asylum system, you know, I think you often see kind of people who are more psychoanalytically inclined, you know, saying all of the issue started in 1980, right? It started when the DSM-III, [ Beatrice laughs ] which was the edition that became extremely biopsychiatric, like, "this was when all the issues started." And it's like, well, what about all the people that were locked up for hundreds of years before this? You know? You see this to and fro throughout history, from kind of the bloodletting and the purging and the people who thought that, you know, it was about the four humors, it was in the body. And then you get people coming along and saying, no, it's social, it's moral, and, you know, moral treatment, so much of it was about putting people on the production line. You know, asking people to produce toys, clothes books, as supposedly a form of treatment. And so yeah, I think through this kind of looking at the back and forth throughout history, between different blanket approaches, I want to kind of really point towards the fact that yeah, that is no one approach. And also that, you know, to name the fact that the desire—I think, even the desire to say, oh, after capitalism, there'll be no mental illness or no madness, like that desire is also in line with eugenicist desires.
Beatrice Adler-Bolton 24:29
Mhm.
Micha Frazer-Carroll 24:29
It's in line with the eugenicist project, the idea that some future utopia will not include people who are not able bodied or able minded. And I think that's kind of an explicit contradiction. Again, the mess. [ Both laugh ]. There's an explicit contradiction that I think we have to hold that we will have madness, and we will have experiences that we categorize currently under disability, those things are always going to exist but equally, we also want fewer people to suffer. And I think that that contradiction is really important to hold. Because it's not going to be simple. It's not going to be straightforward.
Beatrice Adler-Bolton 25:08
Absolutely. And I mean, I really appreciate, you know, that you're pointing out that like, even those claims, right, and those, as desires, whether it's social or political or careerist aspirations, even—you know, oftentimes those are coming from a place of like, genuinely wanting to reduce suffering out in the world, right? And I think it's the kind of boundaries and frameworks that we're forced into, the kind of limiting of the political horizon and of imagination that occurs as a result of like forcing, you know, these experiences into a clear set of boundaries that actually is so sort of productive of very large systemic harms that could be quite easily remedied by changing the way that we think about sort of the political reality of madness as a category, right? So you know, as we've been talking about the concept of madness is not fixed. It's not a biologically determined category. It's a socially and historically defined set of ideas. It's evolved over time. It's been influenced by social, cultural, political, economic contexts, etc. You know, medicalization. And, you know, while we're rejecting the idea that capitalism, for example, is solely responsible for madness, or that, you know, it's solely sort of like about sort of "control." you know, it's important to confront also how madness has been historically constructed as a way to also define social difference and deviation. As you're saying, you know, the very category itself is part of the construction of sort of what society would be without people who are put into this category. You know, and the term madness has been used since the 14th century to describe for example, like, "irrational mental states" or behaviors deemed "headstrong," for example. You know, over time, we've seen connotations linking madness with foolishness or with danger to themselves, to others, to society itself, you know, the ever changing sort of definition of madness. And its association as a kind of "primary deviance" among a very sort of broad constellation of deviance from a norm, right, is really sort of, I think, a very important way that madness as a category actually serves the interest of capitalist economies. For example, you know, madness is used to mark individuals for abandonment and exploitation in alignment with various sociopolitical or economic goals. You know, we give the example in Health Communism of the Trans-Allegheny Lunatic Asylum, which is in West Virginia in the United States, which, you know, between 1864 and 1889, incarcerated thousands of people for things like "immoral life," "laziness," "novel reading," "politics," "uterine derangement syndrome," or "desertion by husband." I mean, some of the kinds of frameworks are so ludicrous, right, that you look at this and you're like, ah: socially constructed absolute garbage, they put someone in a, you know, lunatic asylum for "novel reading" and "politics." Yes, that's totally true. But also, this illustrates how the concept of madness has been manipulated to suit economic, political, and most importantly, you know, a sort of colonial agenda, and the meaning of madness as it changes according to context, and gets messy as we're talking about, it's really important to sort of reframe all of that not around the boundaries of what it is or isn't. But you know, Micha, as you argue in the book, and I'd love to hear you talk about this, like why it's important to instead talk about this in terms of the shared structures and material conditions that shape how we experience madness under capitalism. Not what the label is, but what is the experience once you are labeled? Or whether you're labeled or not, also.
Micha Frazer-Carroll 29:02
Yeah, yeah, and I want to name the thing that you're saying about social reproduction. And like, who, who gets labeled and why changing over time. Especially because I think like, so often, we see people point towards these historical categories and say, you know, that's ludicrous. Like how can we—how could that have ever been considered, you know, a real illness, but don't necessarily question how our current system of diagnosis [ both laughing ] still perform[s] many of the same functions. And how they also, yeah, they are tied to the idea of who are the kinds of people that help this society function in the way that we need it to function under the current economic system. And that, you know, I look at the example of drapetomania, which people often talk about, you know, this proposed diagnosis of Black people who fled from plantations. And like, wanting to name that explicitly as something, you know, a behavior that was disruptive to the system of the plantation. It was disruptive to capital accumulation, again. But yeah, I think—was your question about how people get—what happens once people are labeled?
Beatrice Adler-Bolton 30:10
Yes, but also sort of like, why you're arguing that the way through the—the "quest for truth" is to actually focus on sort of shared structures and material conditions.
Micha Frazer-Carroll 30:22
Mhm. I think because the shared material conditions like, these are the things that are oppressing us. Like I think when we look at, for example, to name again, the history of the asylum, whether it's being constructed as a biological or a social problem, essentially, in society, the asylum is the common experience. And whether that's being named as "madness," as "illness" as biological or social, the fact that particular people are being sorted, categorized, and either warehoused, or, you know, quote, "treated" in a way that is mainly focused on getting them back on the production line, like that is a shared experience. And that is a political thing that completely defines, again, no matter how you conceptualize it, it defines how we experience madness, or mental illness. And I think that, especially, you know, this approach with treatment in terms of always trying to get us back into the structures of work, I think it's important that, you know, there are particular people who will say, well, medication, you know, medication is what I need. I know that it's an illness, because for me, I need medication from a doctor. But then you've got other people who say, well, for me, it's therapy. Or for me, you know, it's "mindfulness," or, you know, this ever expanding list of practices and techniques that we can use to address mental health or madness. But ultimately, I think it's the function. The function is the same for so many of these practices. And that function—and we see it, you know, the way that, for example, mindfulness has been co-opted and deployed in the neoliberal workplace, or the fact that, you know, I know so many stories of people who have been going through workers rights struggles in their workplaces, and they're offered therapy [ laughs ] to deal with a round of layoffs. And yeah, I kind of want to point towards the fact that no matter which frame we use, capitalism, and getting people's bodies and minds back onto the production line, and aligning—realigning themselves with the demands of the market. That is the fundamental pressure. And this is also obviously the site for so many people, the site that makes people unwell in the first place. And then of course, you've also got the people who are completely excluded and disabled by capitalist work. And I think that it's this common structure that we need to be looking towards and organizing around, rather than, yeah, whether we think about it this way or that way.
Beatrice Adler-Bolton 32:58
Absolutely. And I mean, one of the most popular ways that the state understands and measures madness is relative to your capacity to work. This kind of as a way to categorize and mark people that are either sort of "working well" or "incurably mad" will hinge on the sort of factor of can they be given treatment to return to work? As you're saying. But the sort of flip side of that is that the sort of severity of illness or madness, so to speak, is measured also by the capacity to work. And this is, I think, why it's also really important to sort of focus as you're saying, on how people are rendered excess by systems of capitalist production, and how at the sort of same time that you know, folks are abandoned, are, you know, put in positions that are productive [of] or exacerbate distress, you know, that they're sort of then framed as a burden on society and how that kind of becomes this really important dynamic that begins to define all sorts of life chances. I mean, this is, you know, in so many ways, I'm throwing to Ruth Wilson Gilmore's conceptualization of racism as "group differentiated vulnerability to premature death." And the sort of physician's role in certifying madness has this long history in the management and sorting of enslaved people. I mean, in the United States, back in the Antebellum period, you had these things called "soundness courts," where, when folks were being sold as property, they would be evaluated publicly by a physician who would declare if they're "sound" or "unsound." And the really fascinating thing is, if you look at those soundness determinations, they made no differentiation, really, between quote unquote, "mental illness" and "physical illness." And they also pathologize things like very normal behavior, like if someone was upset because they were enslaved and being separated from their family that was pathologized as "unsound behavior" because it could lead to rebellion. And so it's also really important to sort of locate this, both in terms of sort of controlling who is a worker, who's not a worker, certifying that workers are "good workers," right? But that it also connects into a much broader sort of deeper pathologization of the reasons and justifications for treating certain people like property or treating certain people as non-human, right? Because this is a huge part of also sort of how the justification for colonialism is kind of stood up, right? The the kind of "sanity" of white Europeans and the "insanity," the "chaos," the "madness" of like, colonized peoples who need to have sort of order, reason, standardization imposed on them. So also these kinds of logics, like, it's not just about mental illness, or individuals' diagnoses, or what madness is, it's also about sort of, like, how does this reflect the way that colonialism has also structured medicalization and the world that we live in?
Micha Frazer-Carroll 36:11
Absolutely, absolutely. These ideas of "who is a valuable person?" And yeah, how can we get people to either be assimilated into this idea of who's a valuable person in our society, or as you say, the people who are completely abandoned under this system and treated as excess? And that's something I've been thinking about a lot, actually, in the context of the UK, I don't know how familiar you are with like, what's been happening in the mental health system in the UK and recently is like, StopSIM?
Beatrice Adler-Bolton 36:42
I'd love actually if you would get into that, for listeners who are coming from the US context. We have a lot of listeners in the UK, but we have a lot in the US and Canada who might not understand or know what that program is.
Micha Frazer-Carroll 36:54
Yeah, so it's a program that's been rolled out across NHS trusts, across our health system in the UK, which basically kind of enlists police officers into mental health services. So it allows the police to be first responders, to mental health crises, but also to kind of have access to records and things like this. But also as a part of StopSIM we've seen kind of this idea that—I can't remember the exact phrasing of how it's talked about in documents—but this idea that certain people, which I think they call "high intensity users"—
Beatrice Adler-Bolton 37:33
[ laughs ] Ugh.
Micha Frazer-Carroll 37:33
—The euphemisms that, yeah, come from proposals like this. But yeah, what they call "high intensity users" who are basically people who frequently contact mental health crisis services, and yeah, frequently come into contact with them. And this is, you know, unsurprisingly, has overwhelmingly affected women and women diagnosed with borderline personality disorder. And essentially, I think this really points towards the thing that you're talking about, of certain people who are treated as excess or as "unsalvageable" under this system. Because it's, you know, this idea that there are certain people who are going to be given what we'd call treatment within these systems, then there are certain people who are going to be incarcerated by these systems, again, kind of under the guise of treatment, but then you've actually got this emerging, also, group of people who are being told you're not even kind of worthy of being brought into the system because we don't see you as someone who is going to be quote, "rehabilitated," "recovered." And also, again, you know, it's always using the metric of cost effectiveness, you know, how much cost is this on the health system to bring you into it and attempt to, you know, quote, "treat you." And I think that that's, yeah, something that's really important to name is also all the people who are treated as "unsalvageable." And kind of not worth attending to under our current systems.
Beatrice Adler-Bolton 39:06
I mean, the name of the SIM program is so horrific it's—SIM stands for what, like, "Serenity Integrated —"
Micha Frazer-Carroll 39:14
"Monitoring."
Beatrice Adler-Bolton 39:15
Is it "Mentoring" or "Monitoring"? Yeah, so it's, you know, the whole sort of therapeutic carcerality framework, it's such a great and terrible illustration of how the language of cost effectiveness, of cure, of you know, "valuable" and "non valuable" life can structure and really fuel and justify the expansion of police into care systems, for example. You know, the kinds of things that you hear mental health care workers sometimes say, like, well, I—"if I didn't restrain and forcibly detain someone and, you know, sedate them against their consent or will, then I would have no recourse to protect myself." Like you talk about how some of these ideas, right, of like these zero sum choices of, it's sort of like us or them, right? Like, you can, like call the SIM team to come in and, you know, they're encouraging health care workers to like rat people out for using services too much, [or] for being like "resistant to treatment," allegedly. You know? And diverting them—diverting those resources, again—away from the population that's "curable," and diverting those people towards, you know, overtly carceral frameworks of engaging with the state around their healthcare. And so, you know, it's one of those things where oftentimes—sometimes there's this like kind of framework that you might encounter where the idea of sort of like care existing on this continuum, where you have, you know, people who respond to care on one end of it and people who are absolutely "beyond help" on the other and the way that like those two groups who are on the exact same quote, unquote, "continuum" of battling, you know, living with mental health stigma in society, right? As the sort of biopsychosocial model conceptualizes it, you know, are facing completely different worldviews depending on what your diagnosis is, on who you are, it's going to completely shift and change someone's perception of you taking "too much care" and needing to be diverted into a, you know, more overtly carceral approach. You know, you being "a cost burden," "beyond help," et cetera, you know, these are the kinds of ideas that also are really important logics towards structuring capitalism, right? Because in some ways, like, what's happening here, is the state is taking on like a function for private businesses. And they're—you know, state and sort of the medical apparatus, operate as the certifying body, right, of sort of who is a fit worker, and who is not. So in the same ways that we think of these things as perhaps like, you know, giving someone eligibility for access to services, it also, you know, marks that person and is interpreted in terms of like how employers or other people in society—you know, in terms of people, you know, trying to rent housing, trying to, you know, retain custody of their children, trying to access other care, for example, you know, the ways that these diagnostic labels can really get out of control is something that you focus a lot on. And I'd love if you could sort of talk about how that fits into, also, you know, some of the ways that health kind of acts as like a disciplining function when it comes to labor power, that actually a lot of ways we can think about madness as a form of sort of not just punishment and sorting, but also labor discipline.
Micha Frazer-Carroll 42:46
Yeah, I mean, diagnosis has such a huge function in like your outcomes in the world. And I talk about this, you know, the fact that diagnosis—you see these arguments, right, about, is it good or bad? Is diagnosis something that's real or fake? Again. But diagnosis, for many people, can grant them access to things that are life giving, right? It can grant them access to modes of healing, or to the accommodations that they need, but it can also be a pathway towards death for other people. It can, you know, determine, like you say, whether you have access to housing, employment. I talk in the book, for example, in the UK, about trans healthcare. If you're a trans person who's trying to access gender affirming care, if you have a diagnosis, for example, of autism, or a diagnosis of various mental health diagnoses, you can be denied access to your care. And the fact that diagnosis is not this thing that kind of can bring about binary outcomes of good or bad, I kind of say, it's more like a verb. Like it's always moving, and it's always serving some end. And your outcomes depend very much on how kind of power also is threaded through experiences of diagnosis. And the fact that most of us have very little say over the diagnoses that we actually receive. We often kind of talking about diagnoses, again as these inherent internal truths. But actually, you've got similar stories of people—you know, I know people who have had to fight for years to try and get diagnoses taken off their records. Again, like, you know, often things like borderline personality disorder, which can really significantly degrade the quality of care that you can receive. But then I also know many people have had to fight really, really hard to gain access to diagnoses, to get the material things that they need. And I don't see these two things as kind of in opposition to one another.
Beatrice Adler-Bolton 44:47
Mhm.
Micha Frazer-Carroll 44:48
I see them as kind of the function of the same system of power. They might be bringing about slightly different outcomes, but it's the same system of power that we're coming up against. And then—what was the—could you rephrase the second part of your question?
Beatrice Adler-Bolton 45:03
I was sort of asking how, you know, we're talking about, in a way, diagnosis is very neutral. In a way. It's like the problem is sort of like how does it materially iterate out in the world, and to sort of connect that to how it's kind of like a way of the state taking on the function of sort of sorting the population for employers. Sort of certifying who's, you know, "a good member of the body politic" and who's not. So in a way you kind of did answer it, but if you want to sort of speak directly to like how this functions in terms of sort of labor discipline, and reverberates beyond care and treatment itself into the, you know, what the professional literature calls the social and structural determinants of health to really sort of shape your whole life.
Micha Frazer-Carroll 45:50
Yeah, and I think this is important to point towards, as well, maybe for listeners in the US, because I think that we often, you know—the UK healthcare system can often be talked about as like, kind of like not a capitalist one?
Beatrice Adler-Bolton 46:03
Mhm.
Micha Frazer-Carroll 46:05
Because, you know, I think there are so many ways in which actually, it still serves the function—serves functions for the purposes of capital accumulation, right? So this sorting is always about who is able to be a good worker, or not a good worker. And I point towards, you know, these kinds of examples, that—more commonplace examples—that lots of us have experienced, you know, people going for a depression diagnosis, and then being told, oh, it hasn't—"it hasn't interfered with your ability to work, or go about your daily life for more than 14 days." [ Both laughing ] So you can't receive a depression diagnosis! But equally, you know, racialized people, like I talk about, a lot in the book, I talk about the experience of family members. You know, I'm from Antigua, my family's from Antigua. And in Antigua in the Pentecostal Church, which is, you know, kind of a very big thing in Antigua, it's very encouraged—not only accepted, but encouraged—to kind of talk about experiences of hearing voices. You know, hearing the voice of god. Seeing visions, things like this. That's very normalized. But actually, when people in my family came up against the health care system, you know, this is diagnosed or conceptualized as schizophrenia. Which, again, is completely structured around this idea of who is a good worker, and who is not a good worker.
Beatrice Adler-Bolton 47:30
So one of the things that I'd love for us to talk about for a second is sort of the ways that we can sort of think about and sort of handle the messiness of treatment. And part of that is really about thinking through the ways that sort of current dominant models of thinking about it, and of paying for treatment and care, in particular—and this is, again, sort of speaking to your point about the NHS not being a sort of "socialist island within a capitalist state." But being a capitalist system of medicine, actually, you know, this is something Artie and I focus on a lot in Health Communism, but you really can't point to one system and really say, like, okay, you know, here is the model of what we want to do, here in the NHS, this is socialized medicine. Because in fact, like, not only is the NHS sort of existing in this network of, you know, public and private partnerships, it's also about sort of the logic and the design of the system. And one of the things you talk about, is the way the sort of neoliberal logics of personal responsibility, that you're responsible for your health, and you're responsible for your care, and you're responsible for maintaining your body as a—as a good worker, you know. These kinds of frameworks that we've been talking about are all translated into personal responsibility, and then you have the kind of imposed, narrow reality of like, what treatment will be paid for, right? And part of what we're getting at here is that ultimately, sort of what a quote unquote radical politics of mental health would actually call for is a real expansion of a lot of these ideas, not just like, not thinking about the boundaries, but actually a lot more experimentation, a lot more different options, and sort of working against sort of some of the restrictions not saying like, wholesale, XYZ doesn't work and XYZ does, which is often you know, in the kind of realm of like, psychiatric revolution, where you have professionals sort of coming in and saying, like, my technique is the right one, you'll see this kind of like denouncement. Like, you know, the problem is x the problem is y and it's actually sort of that we're looking in a completely different direction when it comes to talking about treatment and efficacy and what treatment is for.
Micha Frazer-Carroll 49:53
Yeah, and I feel like you know, these these debates are rage on of—yeah. Is it medication or is it therapy? You know? What is "the way" to solve this? And I think like you say, so much of it is about not necessarily the practices, but actually what function the practices serve. And we often talk about the practices that we have now as if their function is actually to make people—to reduce suffering and maximize joy. Which is just not the reality of the practices that we actually have, you know, they're about getting you back into the workplace. And I think some of it also is, like, you know, I mentioned before this production line approach. Is being able to embrace slower, messier, more experimental approaches that maybe aren't going to reap quick, cost effective outcomes, you know. And we often see critiques of the NHS, which, you know, talk about the fact that if you go for mental health treatment in the NHS, you're most likely to get medication, or to get cognitive behavioral therapy (CBT). And obviously, there are a lot of huge critiques of cognitive behavioral therapy. But I also know some people who say, you know, it actually worked kind of well for me, or it's my preference. And I think it points towards the fact that CBT is not the issue in itself. The issue is that you're always going to get the quickest, cheapest, most cost effective methods, which you can also see with the huge rollout of things like mindfulness, right, like, what better approach, it's something that you can learn and just go and do it on your own, anywhere, with no kind of material resource necessarily. And I think the call, you know, the call that you make of "all care for all people," I think, is really, what's at the heart of it. Is having, you know, an economic system under which we are able to actually explore, expand—you know, I argue for millions of experiments. Infinite care. The possibility, you know, that there are types of care that we can't currently even imagine under our current paradigms. And also the space—you know, some modes of healing for people entail, like, maybe you get worse before you get better, you know? Or maybe you have to sit with suffering. And you need someone to be patient with you and be with you through struggle. And that's not something that sounds very conducive to a capitalist economic system.
Beatrice Adler-Bolton 52:22
Yeah. How do you do a billing code for that right?
Micha Frazer-Carroll 52:26
[ Laughing ] Yeah.
Beatrice Adler-Bolton 52:27
Whats the fee-for-service calculation on sitting with it for an indeterminate amount of time and doing—you know?
Micha Frazer-Carroll 52:31
[ Laughing ] Exactly.
Beatrice Adler-Bolton 52:33
Yeah, absolutely. Sorry. Please continue.
Micha Frazer-Carroll 52:35
No, but no, yeah, exactly. And I think that that patience—again, it's another explicit contradiction, I think, that we have to invite. I think it's Alison Kafer, who—who kind of describes, you know, people often see disability as this unwelcome presence. And I think, you know, it goes specifically for mental health or suffering. This idea that it's something that must, must be eradicated, it must be quickly suppressed. And I think you see that revealing itself in the logics and practices of the system, right? You know, physical restraint, chemical restraint, sectioning, or detention. All of these things are very fast, they're very blanket, they're things that, as we've mentioned, you know, have the veneer of certainty. You know, that this is the blanket approach that will work. But obviously, we know, from its actual outcomes, that for many people, it's more traumatizing, it can actually produce more suffering in the long run. But yeah, I think that we do need to welcome the contradiction of sometimes being able to hold and be patient with the reality of suffering. But I also think, you know, it entails these experiments and expansions out of the things that we currently even think of as "mental health care." You know, I mean, you'll know much more about this than me. But I think, what was so interesting to me about SPK, and, you know, there were groups in the UK, for example, like Red Therapy, that were very focused on these material interventions. You know, can you come and fight with my landlord with me? Or provide childcare? Or intervene in arrest? And all of these things that we'd never really think of as mental health interventions or forms of care. But actually, you know, these are the sources of so many people's struggles and suffering. And so I think, again, expanding that out. Which, yeah. There's also—there's not really a billing code for that either. [ Laughs ].
Beatrice Adler-Bolton 54:37
No, it's—well, and I think it's so beautiful to see sort of the possibilities that emerge when you give people, like, the go to start imagining their own creative solutions. You know, like the conversations that we have in our server around our sort of ongoing Mourning Group that happens, it's very informal. That's like very different than a lot of like grief groups, you know, that you might be a part of. And part of the reason why it's very different from other grief groups is because it's not a product being sold as a grief group to fix something, right? It's a—just a space for people to come together and spend time with each other and talk. And the model is actually based on the SPK model for part of sort of how they ran their groups, right? Which was, you know, sort of based around there not being really someone there in a position of authority, trying to fix anyone, but about being a sort of collaborative, ongoing, you know, relationship of support, that's got to be negotiated and renegotiated, but that's strengthened through political education, and through solidarity and through, you know, considering the kind of radical contexts of our experiences, you know? And looking towards, not just sort of why we are where we are, but trying to sort of look forward and imagine what can be different, what can we build? What can we try? What can we learn together, and ultimately, you know, these kinds of peer led models, they flourish best out of the light. Right? And one of the things that you talk about, and we talk about, you know, is how some of these really important radical histories or histories of peer led work are harder to see sometimes maybe because it's occurring in the context of, you know, work that's going on inside an institution. You know, a lot of the patient organizing that happened, they produced magazines, zines, flyers, materials, but a lot of times they were being suppressed by the institution administrators and those materials were destroyed. Like there's a—there's very, you know, sort of well known stories in Disability Studies of like, oh, yeah, "apparently this magazine existed here in this hospital, there's one issue, there were supposed to be fifty, it appears the rest were destroyed." You know, these kinds of stories don't have a big home, also, in sort of the left, materialist history canon, too. And one of the things that you do so well, in the book, is you sort of talk about how approaching a radical sort of madness perspective, really is strengthened by drawing from this history of hard to see political activism, whether that's anti-psychiatry for all of its faults, or the psychiatric survivor movement for all of its faults, as well, and sort of building on these mid-20th century movements that are not super well known, whether that's SPK, or, you know, other patient organizing, or whether that's through the professional work of people like R.D. Laing, or Thomas Szasz—who, I love seeing someone come for Szasz, very here for it. But, you know, it's all important towards challenging these individualized perspectives on suffering and illness and what psychiatric power is. But, you know, we're not interested in sort of reproducing these exact historical legacies. But you really, I think, do such a beautiful job of sort of laying out a couple really important histories and also demonstrating how generative they can be to build on. So I'd love to also sort of hear you talk about how, you know, your perspective is strengthened from looking at some of these historical movements?
Micha Frazer-Carroll 58:28
Definitely, yeah, and I think that point you make of like, not trying to replicate these movements, you know, like for like, is so important. Because, you know, we can see mistakes, and we can also see a different historical context, like, the context that we have now is going to call for different things. But at the same time, you know, yeah, like you say, with people like Laing as well, I think like, we can critique, but also at the same time, I think what, for me is so exciting about this period, is that it was this period of experimentation. And this period, you know, again, you see experiments like the experiment—what was it called, the rumpus room? Where, you know, you get lots of people taking LSD and painting on the walls and trying to move through crisis and things like this. And I think, again, you know, that's not necessarily my suggestion for like, "how we fix everything." But I think the fact that people were trying to make space for this kind of experimentation—and explicitly this kind of experimentation, which is so unproductive. [ Both laughing ]. It's really, really dissenting against the kinds of approaches we have to mental health now. I think that that's really admirable. And you see it as well, you know, with patient organizing. So I mentioned Red Therapy, which was a group in the UK, I think, local to where I live in Hackney, in East London. You know, they would have groups where they would get together in a room and they would all just scream. [ Both laughing ]. For hours! Which again is like, who knows how that's gonna work for each person. But again, it's very unproductive. And I think there are stories of them being asked to leave, to vacate the premises, [ both laughing ] and things like this. And, you know, they were also doing creative projects, you know, putting together like zines and pamphlets and things like this, that were, again, trying to connect up—connect up anti-capitalist critiques with critiques of the mental health system. And in this period, you know, you also see lots of conversation, which I feel like we don't see now, like, lots of conversation between anti-racist activists, the civil rights movement, and anti-psychiatry or anti-psychiatry critiques, you know, the gay rights movement and anti-psychiatry, you see this kind of real blurring of the lines between all of these movements, and you know, things like the Dialectics of Liberation Congress in London as well, where you get Black Power leaders like Stokely Carmichael, coming together with anti-psychiatrists like [David] Cooper. And I think that that's just really exciting. And I think it kind of points towards some of the points that I'm trying to make in the book about how like, I don't see a hard line between like, you know, racism, imperialism, transphobia, like all of these systems of oppression. I don't see a hard line between that and like, mental distress, I don't think the line between them is very clear. I think that all of these issues that we're talking about on the left, like they are issues of mental health, they're issues of suffering. And so I think that that's what's really exciting about that period, for me. And I think you also see it, you know, and things—peer approaches—that exist today, you know, some of which have been co-opted within services, but I think still can represent kind of liberatory frameworks or approaches, like, you know, I talked about the Hearing Voices Movement, which tries to take an approach to voices and visions, or, you know, what they describe as seeing or hearing things that others don't. That actually says, okay, well, what if the only approach to this, you know, it's not just anti-psychotics? Which for many people, you know, they can find very distressing. What if there is an approach that's about sitting with your voices, or listening to them, or being in dialogue with them, you know, what other approaches are possible? And yeah, I think that many of these things, as I mentioned, like are not necessarily—you can see why they're not, um. They're not adored [ both laughing ] by the kind of system that we have, but I'm really curious about these approaches. And I'm really curious about approaches—these approaches that maybe more actively dissent against kind of the conditions of capitalist exploitation, you know? I'm interested in these conversations that I see happening in the UK, in mad communities and mad organizing about, you know, how—how can we be more mad? Or, you know, how can we thrive off-work, you know, this kind of thing about how can we actually dissent within the current system that we have? And I think for many people, you know, that's just as valid a pathway to healing, as many of these other pathways.
Beatrice Adler-Bolton 1:03:24
Absolutely. And I mean, I think your book is like a beautiful embodiment of sort of what the call for "all care for all people" really looks like, which is we're not talking about, like, people getting the care that they "need," because that's already a kind of pre-limiting frame based on "need," and bio-certification and all of these dynamics of knowing, and measuring and predicting, and sort of confining what we call "illness" to discrete billable encounters that can be measured and documented and analyzed, right? In order to sort of predict and eliminate these things. Like, this is ultimately you know, what the kind of fantasy of knowing offers us right? Like, the idea that we can know and measure and cure madness is desirable, and it supports these tremendously huge pathways of the economy, right, like billions of dollars flow through the wellness industry, and all of the different things that, you know, become a part of, you know, soothing yourself or treating yourself, or these sort of frameworks that we're talking about, you know, nothing exists in a vacuum. Madness, every diagnosis, has like a social context, a political context, a very intimate relationship with everything else going on in that person's life and the world around them. And fundamentally, you know, I think what your book does so beautifully is challenges readers to really try and learn how to sit with uncertainty and not just feel comfortable with it, but embrace the creative possibility that it actually offers us to acknowledge the real uncertainty that we have, despite all of our, you know, medical knowledge and prowess and sort of, you know, those ideas of being able to know and cure everything, is actually sort of part of how the imperial power of countries like the United Kingdom, and the US are constructed. I mean, we've seen that throughout COVID, throughout the discussion of sort of how the vaccines can be the one and only strategy for fixing it, and we don't need any layered protections, you know, the ways that we've seen the kind of silver bullet logic really reverberate throughout all sorts of different aspects of health, right? Like, I think, you know, in some ways, the idea of like, well, "if capitalism ends, suffering ends" is really built on, like a genuine sort of desire to end all of these different pathways that we're talking about where the lack of care, the restrictions on care, you know, the care itself, the training for the care, the certification for the care, the reporting on the care, the billing for the care, like, each of those becomes this parasitic industry, draining every one of us like trying to squeeze blood from a stone. And ultimately, like, the goal is to produce and reproduce profit, not to, you know, provide for our needs, right? And I think, in this kind of embrace of uncertainty, in the challenge to the reader that you really, I think, do such a good job sort of offering with care, and with a lot of beautiful context, you know, that is where I think some of the most, I think creative and generative sort of sparks are in terms of like, well, what the fuck do we do? Right? Like, if, you know, this is the landscape that we're working with, like, what do we do is a very kind of scary question. And I know it sort of pushes people often towards, you know, looking for that—that sort of fantasy of a truth of a knowing, of a promised cure, right? But that ultimately, sort of, there's so much value and also really just kind of necessary work in refusing that desire and embracing the kind of uncertain frame and all of its possibilities.
Micha Frazer-Carroll 1:07:23
And I think it's so the opposite of what many people maybe expected they would get from a book like this. [ Beatrice laughs ]. I think it's kind of the goal for me is that people might get to the end, and be more confused about what madness or mental illness is [ both laughing ]. I'm more confused potentially, about how we approach it. But I kind of think that that's necessary. And I think, you know, I draw a lot on Liat Ben-Moshe's work about dis-epistemologies of abolition, you know, this idea that abolition is practices, and it is talking about how the world could look.But also letting go of that desire for certainty. You know, abolition is also a kind of psychic process of thinking about, okay, what actually—what if I let go of this needing to know? Needing to know what happens. And I think you see this a lot in conversations about crisis, right? When we talk about detainment and incarceration, people often say, well, what's the alternative? What if someone is going to harm themselves or others? You know, what do we do? And I think that sometimes that really obscures the certainty that we know that institutions so often will harm the person. Like that is a certainty in many instances. But also the fact that the "what if" question, is something that maybe we can also sit with, you know? And I look at various examples, like Trieste, you know, a town in the northeast of Italy, which, under the anti-psychiatrist and psychiatrist, Franco Basaglia, you know, they've got this system of mental health care which aims not to incarcerate. How actually, that letting go of certainty and blanket approaches, kind of gives rise to these creative, more dialectical possibilities of, okay, well, if I can't restrain someone, if I can't detain them, like we have to find another way. We have to have a conversation. We have to think of what is the other option. And the fact that sometimes letting go of certainty can give rise to all of these millions of creative possibilities. And also, that I think when we expand our approach, and kind of let go of these certainties, we do have this understanding that I guess we've both been touching on of like, well, you know, care could be everything. You know, what if care is not just this drug or that therapy, what if care could be anything and everything including, you know, different, indigenous and traditional practices? And what if healing could be everything and not this question of you know, does mental health care come from this institution or that institution or the community? But what if it could look many, many different possible ways? And that being like a thing that we can lean into, and I talked about this in the chapter on abolition, you know, the fact that, again, in terms of certainty, like there is so much uncertainty in the abolitionist project. But also the fact that there's also certainty—and a bad kind of certainty [ both laughing ]—in the systems that we have now, you know, we know that the systems we have now are not working. We know when we look at, you know, psychiatric incarceration, incarceration within the prison industrial complex, like we know, these produce trauma and harm, and that that is a certainty. And the fact I think abolition is often framed as "chaos and disorder," but actually, the realities that we have now are actually extremely chaotic and disorderly. And I guess that's why I think it's probably a good thing that in the book, I'm really trying to emphasize the chaos that we currently have and kind of upend the idea that mental illness or madness is something clear and concrete. I think we're dealing with very disorderly and chaotic realities right now. And also, you know, maybe in some ways abolition is opening up like more possibilities of, you know, chaos, but I also see that as potentially a really positive thing that can give rise to creativity, and other approaches. I also wanted to touch on the thing, I think when you were talking about wellness and stuff, it was reminding me of this, or maybe when you're talking about—I just kind of wanted to touch on the thing of how we never—when we talk about you know, cure and healing and treatment, and all of these things, like the the limits that we place on the possibilities of like, we're never talking about experiencing happiness or joy. We're never talking about anything that kind of goes beyond a kind of this bare minimum that we conceptualize as "health." And I think that's also another kind of creative possibility that I want to open up in the book, is you know, I talk about art, and creativity and music and, you know, community and the fact that so many of these things are not only ways of like keeping us alive and keeping us afloat, but providing us access to joy. Which I think is just not really a metric or a thing that we currently think about in our current system.
Beatrice Adler-Bolton 1:12:37
No and I think the book does that so beautifully. And I love just this one moment in—I think it's in chapter ten, where you talk about Trieste. And you talk about the sort of creativity that comes from having to think of other solutions, right, not having the institution to default to. And Trieste is very, very unique, because it is one of the only places in the world where institutionalization is not an option. And that is a very unique circumstance. And you talk to a former user of Trieste mental health services, who said, I can't even totally, like—I struggle to articulate what it's like to use this to a British person, because it is just so far from the system that we're accustomed to. You know, like that the difference is so extreme that it is difficult for people who are so used to the capitalist approach to managing madness, to even conceptualize a different option. And fundamentally like that dynamic—like that is what we need to destroy. Like, that is the target. You know, that we need to use illness as a weapon against. You know, when SPK calls for using—or "turning illness into a weapon," or "to make an army out of illness," what they're saying is like, they want to end those sort of narrow restrictions on what care and life can be, right? And that these systems, you know, as they exist, they don't benefit us, they only benefit capitalism, right? And we deserve so much more. And I think, you know, Mad World does such a good job of being both an introductory book that is really accessible to people who might not be used to thinking through some of these ideas, but also it was a really high level text that throws a lot of really complicated and contradictory sort of contingent ideas, that build this really beautiful and important text that I think is a great sort of—as SPK would say it's about giving people the toehold. And that's like—from that point, you know, it's up to them to build and do their own things with it. And I think you've put together such a wonderful text that does a really concise job of sort of offering a very important point to sort of start with the stuff but also to completely reframe, adjust or question, you know, the expertise that some people probably have been living with for decades, right? Like that could really benefit from sort of starting fresh and looking at these things. Because ultimately, what our biggest issue is now is not "what causes mental illness?" or how to "cure" it, but how to end the austerity mindset that restricts what care, cure, treatment and illness even is to these sort of narrow possibilities that can be itemized and billed and turned into markets, and sort of wealth for the nation, at all of our expenses.
Micha Frazer-Carroll 1:15:50
Yeah, and the services that you cite, I think that is the mindset or the approach that I'm dreaming towards is something that I think is fundamentally unrecognizable, you know, unimaginable. Which I think in some ways, can sound very kind of floaty and utopian. But I think there is, you know, it represents such a kind of psychic shift in how we think about what is possible. And I think that, to me—I kind of mention this early on in the book—to me, I think that madness, also—to me, that is why madness represents, in some ways, also very liberating possibilities. You know, I talk about the way that "sanity," the way that we define sanity, is the logic of the market, right? It's the death of the planet, it's the death of oppressed people. And that madness, and kind of—you know, in the kind of colloquial way that we talk about it, you know, this idea that you are thinking differently and creating differently—I think, in many ways, like it can offer us some of the creative possibilities that I think will see us out of the situation that we're currently in. And to me, yeah. Madness has many liberating possibilities.
Beatrice Adler-Bolton 1:17:03
I think that's a beautiful place to leave it for today. Micha, thank you so, so much. I really appreciated our conversation and congratulations again on Mad World. It's a triumph.
Micha Frazer-Carroll 1:17:14
Thank you so much.
Beatrice Adler-Bolton 1:17:15
And listeners if you want to follow Micha, she is on Twitter @micha_fraser. Again, Micha's book is available from Pluto Press and it's called Mad World: The Politics of Mental Health. There will be a link in the episode notes. And patrons, thank you so much for supporting the show. We couldn't do any of this without you. If you'd like to help support the show become a patron at patreon.com/deathpanelpod to get access to our weekly bonus episode and entire back catalogue. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore and preorder our co-host Jules Gill-Peterson's new book coming January called A Short History of Trans Misogyny, or request them both at your local library and follow us @deathpanel_. As always, Medicare for All now. Solidarity forever. Stay alive another week.
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