“It's worth remembering that the mad person does not express only their madness. They also expose the insanity of the society in which they live.”
Eliane Brum, in Listen to the Mad
The use of psychiatric medications, as well as the number of diagnoses, has increased in an unusual way for medicine. There are more and more "sick" people, and new ways of classifying them are created periodically.
However, we do not see improvements in the outcomes of these treatments. Instead, we see a growing number of people classified as "chronic," and the current goal seems to be to make them "functional," whatever that may mean.
Culture and ideology: two forces that shape our sense of normality
The terms "normal" and "abnormal" are vague and can be described as fluid (for lack of a better word). However, when these terms are applied to mental health, major differences can be observed across periods, cultures, and countries.
For example, sadness after losing a loved one has always been considered normal and expected. However, in a capitalist world that demands standardized and increased productivity, this state of mourning cannot last too long. There is a boundary where normality exists on one side and a possible mental illness on the other. After all, a person needs to work, and if they cannot, diagnoses and medications are ready to help.
The same happens with other mental states. But who drew these boundaries of normalcy, and why are they modified so often? There is no simple or direct answer to these questions. What can be said with certainty, however, is that standards of normalcy in mental health are defined arbitrarily according to what society deems acceptable and desirable. These terms are also strongly influenced by the world around us.
Thus, illnesses are defined by factors outside the scope of traditional medicine. In other words, the definition comes from societal expectations, not from anomalous organismic functioning. There is no blood test or imaging exam that can reveal this abnormality, nor is there anything that can precisely determine the most appropriate medication to treat it.
The machinery that produces the sick
If the boundaries of normality are drawn arbitrarily, it is worth asking who benefits from their placement. More often than not, the answer points to a system that requires productive, efficient, and, above all, uninterrupted human beings.
Capitalism influences psychiatry not only from the outside but also from within. It defines which suffering is legitimate enough to be recognized and which is simply the cost of living in the world as it is. Anxiety about precarious work, exhaustion from organizing one's life entirely around output, and the numbness that comes from doing meaningless work for eight hours a day are not treated as reasonable responses to unreasonable conditions. They are treated as symptoms.
This is no coincidence. A system that medicates dissatisfaction never has to question itself because, by definition, the problem resides in the person's chemistry, dysregulation, or inability to cope with circumstances that are never put on trial.
The solution is just as individual as the diagnosis: a medication, a therapeutic framework, or a set of cognitive strategies designed to help a person function better within the conditions that caused their suffering.
Rarely asked and rarely allowed is the question of whether functioning better is the same as living well and whether returning to productivity after a breakdown is recovery or simply the successful suppression of a signal that the body was right to send.
The sane response to an insane world
Perhaps this is what Eliane Brum means when she writes that mad people expose the insanity of society. In many forms, madness can be interpreted as a refusal to conform to societal norms, sustain the status quo, or accept what is happening. It is not always a sign of pathology. Sometimes it is clarity.
This is not an attempt to romanticize suffering or suggest that psychiatric medications are unnecessary, because they are not, and they are life-altering for many people in a positive way. The argument is not against treatment but against a model that assumes the individual is the problem without considering the world they inhabit.
More honest psychiatry and society would pause to ask what people are being asked to adapt to and whether they should.