Socialism is the Best Medicine

Socialism is the Best Medicine

Psychiatric Hegemony

March 8, 2017
First published on Mad in America

BOOK REVIEW: Bruce M. Z. Cohen (2016). Psychiatric Hegemony: A Marxist Theory of Mental Illness. UK: Palgrave Macmillan. Hardcover: $99.99, E-book: $68.20 (USD)

Many books expose psychiatry’s crimes against humanity. However, few analyze psychiatry in relation to capitalism, and even fewer attempt this with a marxist analysis.

In Psychiatric Hegemony: A Marxist Theory of Mental Illness, Bruce Cohen breaks new ground. He explains the expanding power and influence of psychiatry in terms of its usefulness to the capitalist system – the more useful it is, the more power it is given, and the greater its power, the more useful it becomes. More specifically, he analyzes DSM-1 through DSM-5 to show how psychiatry has supported capitalism’s neoliberal transition, gaining power and prestige in the process.

A professor of sociology at the University of Auckland, New Zealand, Cohen informs us that,

the current discussion is a critique of professional power not of personal experience and behaviour which may have been labelled (or self-labelled) as a ‘mental illness.’ (p.3)

His target is the ‘mental health industry’ which includes “the entirety of the professionals, businesses, and discourse surrounding the area of mental health and illness.” He labels all who work in this industry as ‘psy-professionals’ whose function is to “normalise the fundamental inequalities in capitalist society as natural and common sense.”

Psychiatric Hegemony

Cohen challenges the theory that the pharmaceutical industry’s lust for profit is the primary driver for psychiatry’s increasing authority or ‘hegemony’ over society. He also disputes the claim that growing inequality and loss of social support are causing more people to become ‘mentally ill.’ Instead, he applies the marxist method to reveal how psychiatry serves the capitalist system. To summarize his argument:

The capitalist class seeks to avoid responsibility for the many problems it causes, so it frames pain and suffering as somehow natural and inevitable. Psychiatry supports capitalism by ‘diagnosing’ socially-created problems as individual cognitive or biological defects, providing pseudoscientific ‘evidence’ for blaming the victims of the system. To use Erving Goffman’s metaphor,(1) if capitalism is a con game, then the role of psychiatry is to ‘cool the losers’ of the system so they don’t squawk, expose the con, and take their revenge.

While suffering may well be increasing, we are mistaken to label it ‘mental illness.’ Warnings about the ‘growing epidemic of mental illness’ followed by calls for more access to ‘treatment’ testify to psychiatry’s success in framing an expanding number of social problems as medical in origin. Psychiatric hegemony results when the medicalization of suffering has penetrated every aspect of society, to the point that sufferers ‘diagnose’ themselves and each other.

Through psychiatric hegemony, then, we are all implicated as ‘at risk’ of mental illness and must constantly self-monitor for potential signs of disorder. (p.90)

The pharmaceutical industry plays an important but secondary role. Pharma enhances the credibility of psychiatry as a medical (prescribing) profession, which increases its usefulness to capitalism.

The predominance of drug interventions does benefit capitalism directly by reducing the need for more expensive institutional ‘care.’ Also, chemical forms of social control are more subtle and raise fewer objections than physical constraint as a means to manage social deviance. However, psychiatric drugs would have no currency without the power of psychiatry to prescribe them as ‘treatment.’

Cohen’s textual analysis of the DSM, from 1952 through 2013, reveals the increasing extent to which psychiatry has positioned itself as an authority on ‘acceptable behavior’ at work, at school, at home, and in personal life – acceptable behavior being defined by what benefits capitalism.

Whereas the DSM-I and the DSM-II make hardly any reference to such arenas of life, the DSM-III dramatically increases such phrasing – a trend which continues as neoliberalism progresses. (p.79)

Work: Enforcing Compliance

Cohen explains how psychiatry frames ‘under-performance’ at work as an individual ‘mental illness’ requiring ‘treatment.’

psychiatry and allied psychological sciences have expanded their areas of jurisdiction into the workplace of the white-collar worker at the behest of capitalist enterprise, where self-surveillance and a continual working on the self have become a part of the increased need for an efficient, flexible, and mobile labour force. (p.98)

He documents how work-related terminology increases in each edition of the DSM, from 10 mentions in DSM-1 to almost 40 times that number in DSM-5, with a significant jump between DSM-2 and DSM-3. By focusing on individual performance, psychiatry depoliticizes workplace conflict.

instead of recognising power disparities in the work environment, new and/or changing diagnostic categories of mental illness encourage workers to problematise the self rather than the organisation or wider society. (p.104)

An expanding service sector requires workers who are sociable go-getters who can sell products and services. Those who are quiet, withdrawn, or shy are disadvantaged. Quoting Ron Roberts, “It is no longer enough just to shift product, one must now do it with a smile, with ‘sincerity,’ with a friendly touch,”(2) Cohen concludes,

the pathologisation of shyness reflects neoliberal capital’s desire for ‘emotional labour’ within the work force. (p.109)

To better “align their ‘expertise’ and ‘science’ with the needs of capitalism,” psychiatry adds Social Phobia and then Social Anxiety Disorder to the DSM.

since the original construction of social phobia in 1980, workers have become more inclined to self-label and entertain the possibility of therapy and drug treatment for their failure to be more sociable and assertive at their place of work. This situation has further legitimated the extension of the psy-professions in the areas of unemployment, job training, and work, reinforcing the neoliberal focus on the self as the site of change, while simultaneously depoliticising the increasingly alienating work environment and constant pressures on employees to upskill and be ‘more employable’ in the jobs market. (p.108)

The ‘mental- health industry’ has penetrated the workplace to the extent that, in 2014, the Bureau of Labor Statistics ranked industrial psychologist as the fastest-growing occupation in the United States.

Youth: Medicalizing Deviance

In this chapter, Cohen reveals how

the increasing infiltration of the psychiatric discourse into the education system serves a significant function for capitalism in enforcing dominant moral codes and economic prerogatives while pathologising any deviation or resistance to these patterns of authority. (p.113)

He points out, “just a hundred years ago cases of mental disorder in children were considered most rare, with there being no specific pathology that psychiatry believed affected young people in particular.” Today, millions of American children are prescribed psychiatric drugs for a growing number of ‘mental disorders.’

Cohen explains this shift by noting that neoliberalism demands greater social control, and psychological testing in the school system is a way to identify and pathologize non-conformists.

As a result of the pressures on teachers and pupils in this neoliberal environment, there has been a need for a closer surveillance of behaviour in school and, more readily, a desire to discipline the defiant child through the application of various mental illness labels. (p.127)

The expansion of psychological testing in schools contributes to the growth of the ‘mental health industry,’ making it more useful to the system.

The psychological sciences have become increasingly useful for teachers and the schools system in supporting the exclusion of troublesome pupils and labelling non-conformist students as mentally disturbed. (p.126)

From its very first edition, the DSM has linked unwanted behavior and conduct in the classroom to childhood ‘mental illness.’ Cohen recounts the shameful history of pathologizing school-age children who do not conform, from the label of “moral imbecile” at the start of the 20th century, through EL (encephalitis lethargica) or “sleepy sickness” in the 1920s, to ‘hyperkinesis’ in the 1950s to ‘minimal brain dysfunction’ in the 1970s, to ADHD today.

Clear within the phraseology and the “symptoms” of ADHD is the concern to medicalise the behaviour of unruly children in the classroom…and, therefore, the APA developing the label of ADHD as a device of social control. (p.129)

Cohen’s analysis reveals that the number of youth-related diagnostic categories rose from 8 in DSM-1 to 47 in DSM-5. More remarkable is the dramatic rise in the number of youth-related words or phrases from 45 in DSM-1 to 1,983 in DSM-5 with a particularly steep rise between DSM-2 (112) and DSM-3 (1024). Cohen explains,

the DSM-III and the growing focus on youth mental illness can be understood as a consequence of the deinstitutionalisation of deviant youth from special education facilities. (p.124)

As tighter school budgets eliminate engaging programs and activities, it becomes more difficult to hold students’ attention. Correspondingly,

With the construction and expansion of the ADHD category to greater numbers of young people, the emphasis is changing from overt disruption to student inattention. (p.133)

Women: Reproducing Oppression

In this chapter, Cohen shows how psychiatry polices the behavior of women in ways that adapt to the changing needs of capitalism.

The wrenching transition from a rural peasant economy to an urban industrial one was particularly difficult for working women. Initially incorporated into industry, they were later excluded by ‘protective’ legislation. Restricting women’s role to reproductive work in the home effectively assigned them to the status of second-class citizens.

Psychiatrists become increasingly important throughout the industrial period as initially incarcerators of deviant working-class women and then as moral enforcers of gender roles, “respectable femininity,” and the sanctity of the family. In this way, the institution of psychiatry takes over the moral role previously performed by religion in feudal society. (p.142)

Psychiatry provided ‘medical’ justifications for women’s oppression. Pseudoscientific theories about women’s ‘weaker’ minds were used to justify keeping women at home and discriminating against them at work.

Women who protested the prescribed female role of submissive wife and daughter, doting mother, and eager housekeeper became targets for compulsory hospitalization, mutilating surgery, and other punitive measures in the guise of ‘treatment.’

In Victorian society, drinking, dancing, or even having a political opinion were all potential grounds for psychiatric incarceration. The confinement of these mainly working-class women in asylum becomes the backbone of institutional and scientific development of the psychiatric discipline, and the over-representation in asylums then provides justification for its focus on mental disease as a distinctive “female malady.” (p.142-3)

Cohen’s analysis of the DSM reveals how the number of ‘feminised’ diagnostic categories rose from 4 in DSM-1 to 24 in DSM-5 with, yet again, a significant jump between DSM-2 and DSM-3.

Today, more women are in waged work than ever before, in effect, challenging the ‘female role.’ To contain that challenge, the number of gender-related words/phrases found in the DSM rises from 105 in DSM-1 to an astonishing 3,096 in DSM-5.

The total count increase witnessed with DSM-III, DSM-IV, and DSM-5 is evidence of the increasing usefulness of psychiatric discourse as a means of ideological control of female behaviour, both policing the boundaries of acceptable gender roles as well as reinforcing heteronormativity. (p.154)

He concludes,

psychiatric hegemony serves to depoliticise the reality of women’s experiences through recasting patriarchal and capitalist oppression as personal distress and individual pathology. (p.149)

Resistance: Pathologizing Dissent

The use of psychiatry to pathologize protest is well-documented.

As a supporting institution of capital the role of the mental health system is to delegitimise such political action as signs of irrationality, dangerousness, and mental pathology rather than a rational and logical consequence of widening social and economic disparities within western society. (p.193)

Cohen recounts some of the stomach-turning atrocities of psychiatry, including,

the normalisation of conditions of slavery, the psychiatric incarceration of political activists, the labelling and drugging of young people with school related “disorders,” the lobotomising of problematic wives, the torture of war combatants, the castration of working class men and women, the pathologisation of the unemployed, and the mass murder of psychiatric inmates. (p.206)

Cohen shows how the number of protest-related words/phrases rose from 11 in DSM-1 to 201 in DSM-5, with two significant jumps: one between DSM-2 (11) and DSM-3 (80); and an even larger jump between DSM-4TR (63) and DSM-5 (201). Of particular note is the increased use of the terms ‘delusions of persecution’ or ‘paranoia,’ from 3 in DSM-4TR to 14 in DSM-5, and a corresponding increase in references to ‘violence’ from 43 to 148. As Cohen points out,

The irony of psy-professions’ focus on political violence as symptoms of pathology is the denial of their own involvement in inflicting systematic institutional violence on others…. a contemporary case in point is the American Psychological Association’s involvement in the torture of detainees at US military prisons at Abu Ghraib and Guantanamo Bay. (p.196)

This service is amply rewarded by the capitalist State.

the psy-professions have increased their professional capital and power through promoting a psychiatric discourse which serves to incarcerate, torture, and murder political opposition and deviant groups under the rhetoric of “medical progress” and “acting in the best interests of the patient.” (p.200)

Challenging Psychiatry

In his concluding chapter, Cohen states, “the mental health system is a fundamentally political project” whose priority is not the mental health of the population but social control.

I have drawn on extensive evidence to argue that the psy-professions were created and progressed to regulate and manage western populations through personalising social and economic issues, pathologising political dissent, policing and punishing problematic and deviant groups, and reproducing the dominant norms and values of the ruling elite through psychiatric discourse. (p.205)

However, when it comes to solutions, the book flounders.

Cohen links “ the ‘crisis’ of psychiatry in the mid-1970s, the construction of the DSM-III in 1980, and the wider development of neoliberal policies.” (p.70)

psychiatric discourse becomes increasingly important in reinforcing the dominant goals of neoliberalism, focusing on the self – rather than the group, community, organisation, or society – as the appropriate site for change and ‘growth.’ (p.76)

the psychiatric discourse witnessed in the DSM-III (as well as subsequent DSMs) reflects the emergence of neoliberal obsessions with efficiency, productivity, and consumption. (p.79)

By the time of the DSM-5, psychiatric diagnoses are blatantly mirroring neoliberal ideology in relating mental illness to under-performance.” (p.80) Psychiatric labels increasingly “focus on deficits and failings in character which threaten the productivity and consumption activities of the individual in many social and economic arenas of life. (p.87)

Cohen stresses that “the recent demands of neoliberal capital have necessitated the expansion of the psychiatric discourse to the point where it has become hegemonic and totalising” (p.70), However, he does not explain why neoliberalism needs to exert so much control.


The capitalist class embraced neoliberalism to counter a social and economic threat. The mass rebellions of the 1960s and 70s had helped to defeat the U.S. in Vietnam, demolished the presidency of Richard Nixon, and were demanding higher living standards and greater corporate accountability. Psychiatry also came under siege as activists forced the removal of homosexuality from the DSM and campaigned against the inclusion of gendered ‘diagnoses’ like Self-Defeating (Masochistic) Personality Disorder and Pre-Menstrual Dysphoric Disorder.(3) Add to all this an economic recession and a falling rate of profit.

Neoliberal policies aim to boost the rate of profit through deregulation, cutting social programs, transferring public assets and services to the private sector, lowering corporate taxes, and gutting unions. To support these policies, neoliberalism exalts individualism – the claim that social programs promote laziness and reduce productivity, that no one is entitled to anything, that one should work for what one has, and that too many people are ‘freeloaders.’

People naturally resist deteriorating living conditions, so coercion becomes more important. The penal system manages the law-breakers, and psychiatry manages the rule-breakers. Both institutions have expanded tremendously since the mid-1970s.


Why does Cohen not acknowledge that psychiatric hegemony developed in order to counter popular revolt? Strange as it may seem, some marxists believe that the victory of the working class over capitalism is ‘inevitable’ or ‘destined.’ In Cohen’s words,

Given the oppressive economic conditions that workers endure under capitalism, Marx prophesied the proletariat revolution as inevitable. (p.71)

Ultimately, [capitalism] is a system defined by the permanent struggle between the proletariat and the bourgeoisie over the means of production – a conflict which the workers are destined to win… (p.30)

Religious concepts like ‘inevitable’ and ‘destined’ have nothing to do with genuine marxism. Marx never ‘prophesied,’ because the outcome of struggle cannot be guaranteed. He stated that the working class has the power to defeat capitalism; however the outcome could also be “ the common ruin of the contending classes.”(4) This could happen through war or environmental destruction. Marx emphasized that what happens in the future depends on the choices we make today.

Cohen believes that the defeat of capitalism is assured, so he does not concern himself with the class struggle but on what can be done ‘in the meantime.’

My Marxist argument necessarily entails the end of capitalism, yet there is also plenty that can be done to subdue and diminish psy-power before the current economic order finally collapses. (p.207)

Even if it were true that capitalism will eventually collapse of its own accord, why not do everything we can to bring that day closer, to prevent as much suffering as possible?

Cohen’s marxism is mechanical; it has been stripped of all revolutionary dynamic. The heart of marxism is the self-emancipation of the working class, which is now the majority of humanity and the single greatest threat to capitalism. Yet the working class appears in this book only as victim, never as liberator.

Capitalism needs psychiatry to impose social control because it fears working-class revolt. The greater the threat, the greater the need for repression. Cohen sees the repression, but not the potential power of the working class that makes such repression necessary. This leaves him with no workable solution to the problem of psychiatric hegemony.

Class power

Early in the book, Cohen acknowledges class divisions in medicine.

the exploitative work relations within capitalist societies are replicated within the rigid hierarchy of medicine, with high-waged, upper middle-class consultants holding a great amount of decision-making power at the top, the lower middle-class nursing managers administering consultants’ needs in the middle, and – holding no power whatsoever and subject to the whims of health managers – the low-earning working-class orderlies and auxiliary staff at the bottom of the pyramid. (p.32)

If the working class holds “no power whatsoever,” then why the need for repression?

While it appears that workers have no power, this is an illusion. When workers strike, ‘business as usual’ grinds to a halt.(5) When workers move into action as a class, they not only have the power to stop producing or serving capital, they can also redesign work, and therefore society, to meet human needs. This is the power that capitalism most fears, the power that can bury it. Cohen does not acknowledge this, and he dismisses the working class as a force for social change.

While (rightly) condemning the ‘mental health industry,’ Cohen (wrongly) condemns everyone who works in it, “not only the psychiatric profession, but also allied groups such as psychologists, counsellors, psychiatric social workers, psychoanalysts, and the many other ‘talk therapy’ professionals,” on the basis that

The psy-professions are not on our side, they have never stood up for us. In fact, quite the reverse. As we have seen in this book, the class interests of the psy-professions closely align with the ruling elites… (p.207)

This is simply untrue. Like all institutions, the ‘mental health industry’ is divided by class, between the few who set policy and the many who carry out orders.

Common interest

While understandable, it is a mistake to counterpose psychiatric survivors and workers in the ‘mental health industry.’

Psy-workers are as vulnerable to psychiatric victimization as any other group of workers, if not more so.(6) And a great many psychiatric survivors (or their family members) become counselors and psychotherapists in order to provide better care than they or their loved ones received.(7)

Many people who work in the psy-industry write, organize, and campaign against psychiatry, including those who blog on websites like Mad in America.

Many psy-workers are sickened by jobs that promise to help, yet too often hurt. Others risk their livelihood to demand that human needs come before profit-making.(8)

In short, there is a large base of workers in the ‘mental health industry’ whose class interest conflicts with those who decide policy, and this is true of every institution under capitalism.

Capitalism is an all-encompassing system of relationships which means that we are all “implicated in systematically serving the interests of the powerful.” (p.8) All paying jobs serve the capitalism system, even if the people doing those jobs are trying very hard to do something else.

The fact that we all participate in reproducing capitalism every day does not stop people from rebelling. On the contrary, it promotes rebellion, because our best instincts as human beings are repeatedly violated by the work we are expected to do to serve a brutal and brutalizing system.

Cohen is correct that most psy-workers are bamboozled about the value of what they do – believing they are making the world a better place, when they are actually contributing to psychiatric hegemony. Nevertheless, most do not enter the industry to serve as agents of oppression, and when they realize they are, they can become magnificent fighters against it. Marxism calls this a ‘contradiction.’ Institutional Ethnography calls it a ‘disjuncture.’ Psychology calls it ‘cognitive dissonance.’ These conflicts provide openings for consciousness and behavior to change.


Cohen rightly concludes that the institution of psychiatry must be abolished, yet he offers no workable way to do this. Instead of supporting workers to challenge capitalism and psychiatry, he writes them off.

Thus, despite having some psy-professional friends and colleagues whom I continue to work with on various research projects, I would at this stage be a fool to recommend anything other than the wholesale abolition of their profession. (p.208)

How ‘their profession’ would be abolished is never explained. Once the working class is dismissed as a force for social change, the only weapon left is moralism. And moralism has no power to accomplish the goals that Cohen identifies.

Firstly, we must remove psychiatry’s compulsory powers. This includes the power to incarcerate and to enforce shock treatment and drugs – including the use of compulsory treatment orders…Secondly, the prescribing rights of the profession should be withdrawn…thirdly, ECT needs to be outlawed. (p.208-9)

Who will remove psychiatry’s compulsory powers? Who will withdraw psychiatry’s prescribing rights? Who will outlaw ECT? Cohen replies,

This involves the disruption of the psychiatric discourse on many fronts through an alliance of political activists on the left, psychiatric survivors, critical and radical academics and students, and community leaders. (p.207)

These groups have important contributions to make. However, on their own, they do not have the power to defeat capitalism, and psychiatry cannot be abolished without abolishing the system that requires it. As Cohen has shown, the two are organically linked.

A revolutionary working-class would have the power to abolish capitalism and psychiatry. In the absence of such a force, one can mount only a moral challenge. Capitalism is more than capable of repelling moral challenges; it enlists psychiatry to label them paranoid.

This is an expensive book and a difficult read, and many of the arguments have been stated before. Nevertheless, Cohen provides new insights into the growing power of psychiatry in general and biological psychiatry in particular.

Psychiatric Hegemony is a welcome contribution. However, it takes us only part of the way. We need revolutionary marxism to take us the rest of the way. As one psychiatric survivor declared,

To be clear: ‘helping rooms’ [for psychiatric containment] are the problem, not necessarily their employees. I have sat at tables where hospital workers and psychiatric survivors alike acknowledge them as traumatizing, sometimes for both sides. Many psychiatric hospital workers find their work miserable and exhausting, in part because they must act in unnatural, professional (code for distant), and sometimes violent ways towards people. But insofar as staff hold all the power in these rooms, we need them to revolt.(9)


  1. Goffman, E. (1952). On cooling the mark out: Some aspects of adaptation to failure. Psychiatry: Journal of Interpersonal Relations, Vol.15, No.4, pp.451-463.–files/19520101-on-cooling/19520101%20On%20cooling.pdf
  2. Roberts, R. (2015). Psychology and capitalism: The manipulation of mind. Alresford: Zero Books.
  3. Caplan, P.J. (1995). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s normal. Addison-Wesley.
  4. Marx, K. & Engels, F. (1848). The manifesto of the communist party. Chapter 1.
  5. Rosenthal, R. (2014) Rank and file rebellion: The 1981 Ontario hospital strike. Toronto: ReMarx Publications.
  6. See Chapters 3, 8, & 9 in Burstow, B. [Ed.] (2016). Psychiatry interrogated: An institutional ethnography anthology. Palgrave MacMillan.
  7. Lewis, S. (2015). The skeletons in my closet. TEDx.
  8. Winslow, C. (2015). When workers fight: NUHW wins battle with Kaiser. Beyond Chron, Nov. 24.
  9. Morgan, S. (2016). The helping room. Mad in America, October 27.



  1. I am somebody who has suffered multiple times at the hands of the so-called “Mental Health Industry”. It continues to scar me to this day.

    Your article was very good up until the header labeled “Common Interest”.

    I understand that you are trying to apply Marxist criticism to the “personal responsibility” narrative that is so often abused, but there is a limit.

    “I wasn’t in charge, I was just following orders” was not an accepted defense at the Nazi trials at Nuremburg, it should not be an accepted defense here either.

    I suffered abuse that stripped me of my humanity at the hands of those “just following orders”, at their physical not just metaphorical hands. Yes I agree that most of the guilt lies with the top decision-makers, but the footsoldiers also hold guilt for their respective roles in the atrocities meted out in the past and also right as we speak.

  2. I agree with you, Dustin.

    People who work in the psy-industry must choose between acting as professional agents of oppression or organizing as workers to demand compassionate and respectful care for our patients.

  3. Susan, thank you for your answer. But also, when I mention points like you made in your article to others, sometimes they say:

    “Sure, there have been abuses by psychiatry, but Marxism could not possibly be the answer. Look at all of the psychiatric abuses that took place in the USSR. Look at how psychiatry was used to torment dissidents there. So Marxism clearly doesn’t eliminate psychiatric abuse.”

    I find it very hard to answer that objection.

  4. Equating marxism with the USSR is like equating democracy with the US. Both are false equations. Both keep people in the USSR and in the US resigned to the way things are.

    There was a genuine working-class revolution in Russia in 1917. For a short time, workers, soldiers, sailors and peasants formed a democratic government that took Russia out of the war, dismantled the Russian Empire, and removed many of the oppressions suffered by women, homosexuals, Jews, and other oppressed groups.

    The Russian Revolution sent shock waves around the world, inspiring popular revolts in Europe, Asia, and North America (Seattle General Strike – 1919). This was a major threat to capitalism, and capitalism responded by sending 14 armies into Russia. The resulting civil war and the subsequent defeat of the German revolution left the Russian working-class weak and isolated.

    In the 1920s, Stalin seized the opportunity to launch a counter-revolution to reinstate capitalism in Russia. This was no easy task, so Stalin targeted anyone who might challenge his leadership in a series of public purges or show trials where guilt was assured for ‘enemies of the state.’

    Under Stalin’s totalitarian regime, all of the old oppressions returned. During the revolution, people debated freely and constantly because they were actively involved in building society. Under Stalin, dissent was brutally suppressed through the use of secret police, prisons, and psychiatric incarceration.

    We are saddled with a global capitalist system that lies about everything, including what really happened in Russia and the even greater prospects for revolutionary transformation today.

    Marxism is a powerful method for understanding and changing the world. You can learn more here:

  5. Susan,

    You said that you don’t consider the USA a democracy. Is the Electoral College the reason why? Would abolition of the Electoral College transform the USA into the kind of democracy you would be ok with?

  6. Genuine democracy means rule by the people. It means that ordinary people get to make the decisions that affect their lives.

    If most people wanted medicare for all, then that would happen. If most people did not want war, there would be no war. If the majority wanted to stop burning fossil fuels and invest in renewable energy, then that would be done.

    On a day-to-day basis, workers would decide together how they want the work to be done. Teachers and students would decide together what kind of learning system they want. Neighborhoods would decide what amenities they want to provide.

    We could solve problems with no consideration of whether it is profitable to solve them. All that would be required would be that people are willing to do the work. We could choose to feed everyone in the world. We could choose to make medicines available to everyone who needs them.

    None of this is possible under capitalism. We have a sham of democracy, where we only get to vote for candidates who will manage capitalism. This locks us into a system of perpetual war and a deteriorating conditions.

    In a sham democracy, elected officials are not accountable. They can say whatever they want, and once elected, do the complete opposite. Or they can use their position to enrich themselves at the expense of everyone else. In a real democracy, such people could be voted out immediately.

    We have many examples of real democracy, when workers took control of society: the Paris Commune of 1871, the early days of the Russian Revolution, Catalonia in 1936, the Seattle General Strike of 1919, to name just a few. These examples show us what is possible.

  7. What is your opinion of the system of democratic socialism in Venezuela that started under Hugo Chavez in 1999? Would you consider that an example of genuine democracy and socialism?

  8. These are good questions that I cannot fully answer in the short space allotted.

    ‘Democratic socialism’ ‘state socialism,’ and ‘social democracy’ all describe the capitalist welfare state, where the state funds social programs like medicare.

    State-funded programs are generally superior to private enterprises – witness the superiority of the Canadian medical system over the American system. However, state-funded programs are constrained by the amount of funding that the capitalist class is willing to invest in them. In Venezuela, the drop in oil prices combined with ongoing sabotage by the capitalist class have devastated its social programs.

    Socialism cannot come from electing certain people or parties into office. Any attempt to do so would trigger a military coup, as happened in Chile in 1973.

    It is impossible to sustain socialism in one country. Capitalism is a global system, and genuine socialism must also be a global system.

    Real socialism can only be achieved from below, by the self-activity of millions of ordinary people moving to take collective control of their lives and society. It is the ultimate form of democracy, something the capitalist class cannot possibly imagine.

  9. Susan, I purchased a copy of “Psychiatric Hegemony” (the book discussed in your post). I found the book to be very turgid and abstruse.

    Also what is supposed to be the main thrust of the book, the Marxist interpretation of psychiatry, seems to get lost in a sea of repetitive details that have been said before by many authors (such as the fact that no biological marker has ever been found for any “psychiatric illness”, the fact that they don’t show up on scientifically objective tests such as brain MRI, the fact that psychiatrists cannot tell the difference between those deemed “truly mentally ill” and those who are “faking it”, the fact that the psy professions have always hewed to “the times” rather than science by creating false diseases such as “drapetomania”, “dysesthesia aetheopica”, etc., etc., etc.)

    20 or even 10 years ago this stuff was still new and revolutionary, but today it’s been said and said again. For the purposes of Cohen’s (2016) book, in which he openly purports to offer a criticism of psychiatry that goes beyond just these things, it needed a brief mention and then a move-on-to-the-main-topic, not a repeat-and-repeat-again.

    Markedly, the chapter on how psychiatry is used to enforce labor compliance with capital (entitled Chapter 4: Work: Enforcing Compliance) receives only 14 pages including endnotes out of the 221 page work, i.e. a little over 6% of the work. In a Marxist critique, this chapter needed much more time than the author spent on it and the things that had been repeated and repeated over and over again by other authors needed much less time.

  10. Dustin, I agree with all of your criticisms. This book is written for academics and not being an academic, I struggled to get through it.

    And yes, Cohen should have paid a lot more attention to the ways that psychiatry is used to subordinate workers.

    I struggled with making these and other criticisms in my review. I decided to emphasize what was useful in the book.

    This is an expensive book, and if you regret buying it on my recommendation, then I will reimburse you for the cost of it.

  11. Susan, something I learned from you is that according to Marxism the most fundamental conflict of our time is the conflict between workers and capital and that other oppressions that may seem unrelated often come out of that. The author does have somewhat decent chapters on the increase of “femininized” so-called “mental illnesses” in DSM-5, so-called “mental illnesses” that target youth (that were used to target me personally for dehumanizing abuse), etc., however even the content in these chapters is very repetitive to what others have written before. To use your word, the book “flounders” because it does not emphasize nearly enough why this stuff is happening according to a Marxist perspective. I’m still very new to this Marxism stuff (not the fake Marxism, the real Marxism), but the central theme of Marxism regarding psychiatry seems to be that dehumanizing abuse of “psychiatric patients” such as I went through does not spring up out of thin air, but comes ultimately out of the oppression of labor by capital. And also, that the problem is not reformable in and of itself (i.e., within the current system), as the author seems to at least partially imply, but can only be rooted out when the oppression of labor by capital is rooted out. Am I getting it right?

    I paid the high price for the book in part because I wanted to truly understand the forces at the root of what I went through. I feel that by not spending nearly enough time on the central core: psychiatry in the service of capital to oppress labor, that the book failed to deliver the value for the high price paid.

    • Dustin, I agree with your analysis, and I couldn’t have said it better. All of our oppressions, including psychiatric oppression, are rooted in the conflict between capital and labor, however not in obvious ways. The challenge for marxists is to reveal this connection. Cohen makes a good start, but by writing off the working class, he falls into reformism.

      A convincing marxist analysis of the psy-industry has not yet been written because of the distortions created by Stalinism and the Cold War and ongoing efforts (East and West) to rob workers of their history and erase the true meaning of socialism. As a result, many marxists are uncritical of Freudianism or biological psychiatry.

      Despite its problems, Cohen’s book is useful, something to build on. I am writing my own book on the subject, and I invite your collaboration, along with that of anyone else who might be interested.

    • While Cohen does repeat criticisms of psychiatry that have been stated before, capitalism’s need for the psy-industry means that these criticisms are consistently ignored. So I have no problem with them being restated.

  12. Susan, I do think that Cohen’s book has some value, and I agree that even criticisms of psychiatry that are repeated and repeated and repeated again are often ignored by the larger society. The issue is that given the high price tag, I expected something really special and unique that would be worth the $84.99 that I paid. I would have gladly paid half that for what Cohen’s book is worth, but the price paid is simply not commensurate with the value received.

    I’m sending the book today to the returns department via UPS. Perhaps Cohen and his publisher can consider releasing a paperback version at half hardcover price or cheaper, or drastically lowering the price for the e-version (whose price is not significantly different from the hardcover version that I purchased).

    This would be the best and most moral thing for Cohen and his publisher to do, as it would put his material much more within the price range of working-class people who truly need it. I can tell you right now, Susan, that there are plenty of struggling workers and unemployed for whom $84.99 is a lot of money. It’s not an exaggeration, Susan. I can show you pictures of grinding poverty and desolation right here in the United States that look like they were taken in a third world slum. And it’s only getting worse in many places here where the Great Recession never really ended.

    On second thought, now writing that out, perhaps the most moral thing for me to do would be to hold onto Cohen’s book and give it away to someone who is suffering what I suffered from the so-called “mental health industry”, so that at least they can have some sort of answers coming from an authoritative source. What do you think of this idea?

  13. This book was written by an academic for other academics. Academia emphasizes being right over being useful, so academic books are generally too expensive for working people to buy and too difficult to read.

    I will not be passing my copy of Psychiatric Hegemony to anyone. I prefer to give people copies of Whitaker’s books.

    Books that make people feel stupid, regardless of the value of their content, cannot build the clarity and confidence that workers need to be able to change the world.

  14. Susan, I ended up holding on to the book in the end. I ended up seeing things more your way in the end, with my gratefulness about another addition being added to the critique of the “mental health” industry outweighing my other concerns.

    What I ended up realizing is that although the chorus of voices speaking out against the so-called “mental health industry” is getting larger, the bottom line is that it is still not nearly large enough. Looking at it from that perspective, I think that the book is a welcome thing, despite its flaws.

    How are you doing? You haven’t posted a new article in a while. Are you busy with your new book you’re writing?


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