A SOCIAL model of madness is concerned with identifying the social causes of mental distress and fighting for a society in which people who live with such distress can flourish. 

The disabled people’s movement used the social model of disability to campaign against social barriers encountered by people with physical impairments. 

They identified these barriers, rather than the impairment, as being the cause of disability. 

Attempts to replicate the social model of disability for mental health have been complicated because societal abuses are implicated in the creation of the distress. 

This distress might be called the impairment and precedes any disabling barriers society imposes. 

Unravelling society’s role in creating mental distress is impeded by psychiatry’s monopoly on defining madness, its causes and treatment. Psychiatry’s authority is reified in the Mental Health Act.   

Currently most NHS treatments consist of drugs and positive psychology. 

Cognitive behavioural therapy (CBT) purportedly provides self-help tools for recovery and the recovery model measures progress. 

However, the areas of life to be addressed and our goals are chosen for us, not by us, and are clearly aimed at bringing our thinking into line with the demands of capitalism. It tastes like brainwashing. 

In 2002, then Tory leader Iain Duncan Smith visited Easterhouse in Glasgow, a housing estate I knew from my childhood in the 1960s to be a functioning and lively working-class community. 

Duncan Smith’s theatrical visit showed him misty-eyed, apparently saddened by the torpor of the residents who had allowed themselves and their environment to go to seed.

This was not the Easterhouse I remembered. What had happened? 

At an informed guess I would say Thatcherism had happened; a Thatcherism in which Duncan Smith was deeply complicit. 

In what resembles a case of Munchausen syndrome by proxy, Duncan Smith rushed to the scene of the crime to announce himself saviour. 

Somewhat predictably, he concluded that the social security system encouraged fecklessness.  

Eight years later, as secretary of state for work and pensions, Duncan Smith began to remove disability benefits without mercy, leaving many people destitute and others dead. 

This atrocity continues today. 

The Five Year Forward View for Mental Health, 2014, claimed that work improved mental health and anything that would push someone into work was a valid intervention or treatment. 

We call this the work cure. Being in work would be evidence of the efficacy of the cure, since work now signalled wellness, an idea made nonsense of by the fact that mental distress amongst people in work is endemic. 

The patient in need of care had been transmogrified into society itself and “worklessness” was the disease that was afflicting it. 

As the mad person was now no longer the patient, care could be withdrawn, other than some workplace positive thinking. 

In all of this chicanery, the major mental health charities have collaborated with the government, even taking a lead, winning contacts and honours for senior personnel.   

The psychiatric profession might argue that the financial predicament of their patients lies outside of their domain but this would be disingenuous because they know Improving Lives: The Future of Work, Health and Disability Paper, 2017, brings together the NHS and Department for Work and Pensions and this conflation now informs mental healthcare practices. 

Disabled people protested against this merging but there was no murmur of protest from psychiatric professional bodies. 

I attended a conference where senior psychiatrists promoted treatments according to how quickly they could get people into work.  

The psychiatric profession has acted in bad faith by colluding with an extreme political ideology which harms their patients. 

Despite well-intentioned individual psychiatrists, psychiatry is now a debased profession.  

However, psychiatry itself is in a predicament. Increasingly trauma is being identified as a major cause of madness, often arising from abuse, yet everywhere in our culture, from the exploitation of humans, animals and all of nature at the heart of extractive capitalism, to the everyday domestic violence of patriarchy, trauma is there. 

How can a doctor treat a patient for burns when both doctor and patient are sitting together in the flames?  

I suggest that mental distress is not a health issue, it is political to its core and the psychiatric profession must at least acknowledge the flames. 

Denise McKenna is mental health survivor and activist.