Thursday, 19 May 2016

The magic wand and biological determinism. The two faces of neoliberalism

According to Belgian psychologist Paul Verhaeghe, the psychiatric world is riven by two warring factions. On the one side there is the medical or illness model, which assumes that all mental illness stems from biological or genetic defects. Think of low serotonin levels ‘causing’ depression. Treatment involves taking pills, often indefinitely, to relieve the symptoms. Mental disorders are frequently viewed as lifelong afflictions a person must adjust to. The medical model is the dominant approach, adhered to by the majority of clinicians and doctors.

On the opposite terrain is what is known as the ‘biopsychosocial’ model. Under this way of thinking biology or genetics is relegated to a secondary position. Diagnosis focuses on the broader social context facing the individual and treatment is tailored to a person’s circumstances. This model is also far more open to a person making a recovery from mental illness.

Verhaeghe is resolutely on the minority side of the argument. “The vast majority of mental disorders are not illnesses,” he asserts, “but biopsychosocial manifestations in individuals of broader social problems.”

I believe the biopsychosocial model is essential to understanding how our capitalist, neoliberal society is at the root of many mental and physical illnesses. There is overwhelming evidence of the crucial role factors like childhood poverty, inequality, economic insecurity, loneliness, migration and bullying in increasing the risk of mental illness. According to one UK psychology professor, Richard Bentall, the link between childhood trauma and future psychiatric problems is a strong as that between smoking and lung cancer. In contrast, the medical model of mental illness just presents a closed mind.

But the biopsychosocial model also has a sinister side. It is being used to bully disabled people out of social security benefits by insisting they can make miraculous recoveries from their conditions. Disability, here, is regarded as partially caused by the attitude of the sick or disabled person. Welcome to the world-view of ‘welfare reform’ in the UK.

In defending the government’s transformation of the Disability Living Allowance into Personal Independence Payments, Conservative minister Lord Freud (the same one who believes food banks have mushroomed because they offer a free good) told the House of Lords that ‘we have gone for the biopsychosocial model’.

According to a report from the Centre for Welfare Reform, “the biopsychosocial model has been used to create new obligations for those suffering from common health problems, such as the responsibility to ‘recognise that the sick role is temporary, in the expectation of recovery’”.

In one case, the Department for Work & Pensions funded a medical trial for people with ME which was presented as an exciting success for biopsychosocial intervention. But the standard for ‘recovery’ was lowered after the research began meaning that a person’s condition could have worsened and they were still counted as having ‘recovered’.

Here is 'Biopsychosocial Man' in action: 

The DWP has incrementally re-classified the work related activity group of Employment and Support Allowance claimants (people judged unfit for work) as not really disabled. Before, the government only asserted that people in the WRAG group might be able to work at some point in the future and that full-time work could damage their health. Now, they are subject to a ‘shocking’ level of sanctions and, for new claimants, paid the same in benefits as ordinary JSA claimants, as an incentive, ministers say, to find work.

At the same time the government is trying to re-package unemployment as a personal failing or mental illness, as opposed to a social problem beyond the power of the individual to rectify. There are now psychologists in job centres and job coaches in GP surgeries.

This indicates a fatal flaw in the biopsychosocial model. When it applied to the individual alone and their ‘wrong attitudes’, it becomes coercive, tyrannical and vindictive. Applied to society at large, it is liberating.

Under neoliberalism, an unsuccessful person is either lazy or sick. If they are sick, they need pharmaceutical assistance (which creates a steady stream of profits for pharmaceutical companies). If they are lazy, their misguided attitudes need to be corrected by enlightened experts. Two sides of the same battered coin, which, sadly, is still legal tender. The social and economic organisation of society is taken as a given, and not worthy of consideration.

The medical model strikes me as a dead end, like trying to argue with someone who has their fingers lodged firmly in their ears. But the biopsychosocial model can be both oppressive and illuminating. Perhaps we need to drop the ‘psycho’. A biosocial model of illness has great explanatory power and it can’t be manipulated to scapegoat people and cloak the interests of the powerful.

Monday, 18 April 2016

Basic income versus the economy of coercion

 Proving basic income is affordable is merely the first skirmish in long war

In 2015, an academic from Birmingham University asserted that, contrary to the beliefs of sceptics, basic income was eminently affordable. Using Canada as his example, Richard Pereira quantified the likely effects of savings from the abolition of existing social security benefits, reductions in bureaucratic costs, a smaller burden on public health care and a crackdown on tax avoidance and evasion. His conclusion was that you could introduce a basic income at a ‘decent level’ without additional personal taxes. In fact, basic income might even enable reductions in personal taxes.

One of the priorities Pereira identified in making basic income affordable was plugging ‘tax leakage’ by multinationals and the rich. “Vast wealth is channelled away from public goods though … shady and secretive offshore jurisdictions,” Pereira wrote. “Some of the largest multinational companies are paying zero tax and receiving tax refunds and subsidies simultaneously.”

The release of the Panama Papers has lent Pereira’s claims about the affordability of basic income a distinct air of, to use a contemporary political buzzword, credibility. According to the Tax Justice Network, global offshore wealth amounts to $21-32 trillion. Get hold of that vast wealth and the whole political landscape shifts. Austerity loses its justification and basic income becomes a feasible aim. “Some may disagree with the notion of an unconditional cash grant, or object to it going to everyone. Just don’t say we can’t afford it,” noted one Panama Papers post-mortem.

The realisation that a colossal trove of wealth exists to fund basic income is coupled with a growing awareness that punitive welfare systems don’t even succeed in meeting their most elemental aim – that of saving money. All that checking on people’s fitness to work and whether they have applied for 47 jobs that week as they promised in their job search agreement, costs an inordinate amount of money. According the UK’s National Audit Office, the cost to the taxpayer of the private contractors carrying out fit to work tests is at least £600 million more than the government is forecast to save in benefits reductions. The ‘age of austerity’ should be renamed the ‘age of needless pain’.

But there is a danger that basic income advocates are lulled into the belief that all they need to do is rationally convince the public and policy-makers that a basic income is affordable, will lighten the burden on multiple public services and vastly increase personal freedom. People will slowly see the light.

This, however, is less than half the battle. A great many, very powerful people will not want basic income regardless of how affordable it is. They will fight against it mercilessly precisely because it will vastly increase individual freedom, and their entire worldview rests on human subjection.

The great German psycho-analyst and socialist Erich Fromm advocated a basic income sixty years ago his book, The Sane Society – he called it a ‘guaranteed subsistence minimum’. After refuting the idea that basic income sounds too ‘fantastic’ to be affordable, Fromm was less sanguine about convincing everybody that a basic income was necessary and right. “However, the suspicions against a system of guaranteed subsistence minimum are not unfounded from the standpoint of those who want to use ownership of capital for the purpose of forcing others to accept the work conditions they offer,” he said.

Even more than in Fromm’s day ownership of capital is now overtly predicated upon forcing people to accept the work conditions that are on offer. Economic recovery after 2008 rests upon low wage, insecure service sector work. According to economists, all the net growth in jobs in the US since 2005 has been in ‘alternative work arrangements’, such as contract and temporary posts. In Britain, zero hour contracts have mushroomed during recovery from recession, while other forms of flexible work contract have proliferated. In continental Europe, massive political weight has been expended to make it easier for employers to fire workers. In France, the Nuit debout protests are against a planned labour reform that would place the country’s entire labour laws up for negotiation with employers, including the 35 hour week.

All these changes are inherently about increasing coercion. “The labour market is never free,” says Paul Mason is his book, Postcapitalism. “It was created through coercion and is re-created every day by laws, regulations, prohibitions, fines and the fear of unemployment.”

The rise in sanctioning people on benefits in Britain for not looking for work with sufficient ardour and the hounding of sick and disabled people is not primarily about saving money because, as is evident now, money is conspicuously not being saved. The reason is to force people to take work at wages they can’t live on, make life on benefits so astoundingly awful that zero-hour contracts seem attractive, and to sound a clear warning to those in work that they need to knuckle under and obey. “Economics is the method,” said Margaret Thatcher. “The object is to change the soul.”

By contrast basic income threatens to undo all the hard work of neoliberalism in shoring up the power of employers. At present, as one basic income advocate says, “all negotiating power is in the hands of those offering the jobs and not those looking for them”. Basic income will grant palpable bargaining power to individuals in the labour market, and, for the first time, allow genuine personal choice. Erich Fromm thought basic income would be the beginning of real freedom of contract between employers and employees. Work will have to be interesting, or well-paid enough for people to want to do, or will be automated because no-one will.*.

But to the rulers of our societies this represents, not a dream of liberation, but a nightmare of the collapse of social coercion. Who knows where such a society will lead. Marilola Wili of the Swiss group, Generation Basic Income, contends that basic income will “unpredictably set human forces free in ways one may have never thought about”.

“Work for a salary is the bedrock of the system,” says Paul Mason. “We accept it because as our ancestors learned the hard way, if you don’t obey, you don’t eat.” Basic income will loosen that bedrock and quite possibly, in time, smash it completely. For that reason, many people at the summit of society will do anything to ensure it doesn’t come to pass. Let’s not kid ourselves, achieving basic income will be an almighty struggle. But it’s a struggle we need to embrace.

*Automation represents another danger basic income might pose to capitalism. According to Karl Marx, ‘the most fundamental law of capitalism’ is the tendency for the profit rate to fall as machines replace human labour, which is the ultimate source of value. If basic income cause a spurt in automation and a reduction in labour intensive employment, as unpopular jobs are increasingly mechanised, then profit rates may well, in time, crumble. Capitalism in the West has become reliant on low-wage, low productivity but labour intensive service sector jobs, which do not have to be done by people and in the future almost certainly won’t be, regardless of whether basic income is adopted. But basic income will accelerate that process. Human, sweatshop labour in China and East Asia has provided an enormous boost to profitability for multinational corporations, but that source of profit is drying up as the Chinese economy, and thus globalisation, slows. It is also true that, according to Marxian economics, various forces counteract the tendency for profit to fall, such as increased wages boosting consumer spending. Basic income could also be an offsetting force to falling profits, so its economic impact may be complicated.

Thursday, 24 March 2016

Iain Duncan Smith and the cruelty of the work injunction

Anything Iain Duncan Smith is “incredibly proud of” should be picked up by robot arms, placed in a hermetically sealed container and blasted off into outer space as soon as possible. Disturbingly, IDS is merely the zealous carrier for a political virus that has infected all but a few politicians.

I speak of the work obsession.

In his resignation letter, the former work and pensions’ minister managed not to mention the 1,390 people who died after a tribunal found they had been wrongly declared fit for work.  What he did find space for was noting his incredible pride in generating ‘record rates of employment’ and cutting the number of ‘workless households’.

It would be churlish not to point out that many of the brutal methods employed to achieve this outcome – the work capability assessment and sanctions for disabled people - were introduced by the previous Labour government. But what is worrying is that while some deplore the methods, everybody seems to agree with the aim.

Rich country economic think tank, the OECD, perennially underlines the urgency of increasing the ‘labour participation’ of women and older people. Disability charity Scope, which advocates ‘fundamental reform’ of the work capability test, wants a million more disabled people into work by 2020.

In 2006, a DWP study found a ‘broad consensus’ among employers, unions, disability groups and the main political parties that work was good for the health of sick and disabled people.

The work obsession began in earnest under New Labour. NL ministers waxed lyrical about the transforming effects of hard work. To underscore the message, the Department of Social Security was symbolically re-named the Department for Work and Pensions.

Unemployment was gradually usurped by the adjective, ‘workless’. Less a word than an accusation, being ‘workless’ meant there was something wrong with you, a psychological flaw, and you needed to be returned to the path of righteous employment.

The idea that work is good for you has become so ingrained among the political elite that the fact that it often isn’t does nothing to dent the enthusiasm. In reality, only well-paid enjoyable work is good for you; low status, badly-paid jobs aren’t, amazingly enough. The work compulsion is such an article of faith that even right-wing diatribes include two million stay at home parents in (entirely fallacious) calculations that people on benefits have more children.

But at the high tide of its influence, there are signs that the work obsession is running out of steam.

Part of the reason is that the work obsession has always relied on the social function performed by work rather than what it actually is in bare economic terms – in a capitalist society economy exploitation and profit-making for others.

Thus, stable jobs help people with mental health problems recover, employment enables people with disabilities to escape ghettoization and contribute to society. Going further back, the huge movement of women into post-marriage work after the 1960s meant financial independence and an escape from compulsory domesticity.

Work has been very consciously linked with escaping domestic drudgery and isolation. “I very passionately believe,” government minister Chris Grayling informed the BBC in 2013, “that if we could help people back into work, they are much better off than if they are left stranded at home on benefits for the rest of their lives.”

But in the putative economic recovery we have experienced over the last five years, the sheen has been systematically stripped from what is meant by ‘work’. We are not talking about stable, good jobs but bare-faced exploitation. Zero-hour contracts have mushroomed post-recession, but are merely the ‘tip of iceberg’ of flexible employment practices, such as extreme part time contracts and key time contracts.

According to researchers these ‘flexi-contracts’ are creating ‘a culture of servitude’ and generating anxiety and ‘depressed mental states’ among workers. So much for work being good for people with mental health problems. It now causes them.

One of the prime motivations for hounding people off out of work benefits is that paying people to do nothing is a drain on resources. Think of that enormous ‘welfare bill’. But unless you produce programmes for Channel 5, it’s a fallacy that moving into work of some kind means you move off benefits. Numbers on working tax credits are double what they were in 2003. But greater ‘labour market participation’, merely means people now work for their poverty.

Without this huge state subsidy, the economy and consumption would collapse. But the situation cannot endure forever. A 2013 study estimated that 47% of current jobs in the US could be supplanted by computers by 2033. Automation now threatens not only manual labour but also previously immune areas such as retail jobs and cognitive work. “The scope of these developments means that everyone from stock analysts to construction workers to chefs to journalists is vulnerable to being replaced by machines,” write the authors of the book Inventing the Future.

The demand for labour already weakened from its post-war high point, is set to wane even further. Therefore, in the near future, the injunction that ‘everyone must work’, will cease to make any sense, apart from being inhumane.

What these developments will make apparent is that the work obsessed society we inhabit has gross flaws and is immensely one-sided. To take one example, the need identified by many psychologists for both parents to stay at home and look after young children, is not possible in a society designed around the needs of employers. Many necessary functions labelled ‘domestic’ can be given their proper due in a post-work society, although performed by both genders, not just one as they were in the past.

Many other socially valuable activities will become possible in a society that does not insist on perpetual exhaustion as a condition of citizenship. Democratic self-management, medical breakthroughs, social useful inventions all become feasible in a society that trusts its members, rather than setting out to punish them.

And this would also be a society that would clearly remember Iain Duncan Smith as the dinosaur that he is.