At the beginning of lockdown I came across a meme that made me laugh and laugh. It was Abraham Maslow’s hierarchy of needs, but each level above physiological—safety, belongingness and love, esteem, and self-actualization—was labeled “locked: premium content.” Maslow, for those who don’t know, was a famous twentieth century psychologist who gave his name to a theory that humans must meet certain needs in order to be happy. These include the physiological—food, rest—as well as longterm security, societal esteem, and the ability to achieve one’s full human potential.
Seven months later, the joke feels a little more pointed. The Covid-19 pandemic has been terrible for mental health, but of course it’s not just the pandemic itself; it’s also the attendant unemployment, eviction, and childcare crises that have been created by the state’s failed response. Despite this—that mass material precarity doesn’t naturally flow from the rapid spread of a virus—coverage of these topics in the media often obfuscates these facts, making it seem instead as if they were inevitable or a singular crisis. All of it is just the pandemic.
In any case, a poll conducted this summer by Kaiser Family Foundation found that 53 percent of adults say their mental health has been negatively impacted by the crises, up from 32 percent in March. An even more dire survey from the Centers for Disease Control published in August found that 25 percent of young adults have considered suicide in the previous 30 days.
In response to this kind of data, and the ambient misery of the moment, there has been a deluge of content purporting to offer popular psychology hacks to improve mental wellbeing. These include dressing up to increase focus while working from home, coping with loneliness by learning to ignore your inner critic, and dealing with touch starvation by sending nude photos to your love interest. These types of articles tell readers that, yes, the problems we now face are overwhelming, but they can be solved with a bit of ingenuity and psychological know-how.
While these articles offer useful pieces of advice to be gleaned here and there, the fact they insist that individuals can cope with world-historical (and in some cases completely preventable) crises by changing outfits or sexting is ridiculous. The problems at hand are political, not individual, and so the solutions must be political as well.
Contemporary understandings of mental health tend to focus on the individual and their brain. Mental illness is understood as a neurochemical imbalance—a premise that is true in a basic sense. All mental processes are chemical. The hormone cortisol causes stress and anxiety, while the hormone serotonin makes us feel happy and stable, and the hormone oxytocin helps us strengthen human bonds.
However, what is often overlooked in this analysis is the fact that these chemicals are being emitted in response to constant interactions with other humans and with the world at large: Someone who has just lost their job is likely to experience increased levels of cortisol, while someone who is presently cuddling with their partner is likely to experience increased levels of oxytocin. And yet a lot of discussion and a cottage industry of self-help advice around mental health acts as if humans are brains suspended in vats.
The Covid-19 crises have laid bare this blinkered approach to mental health, revealing the fact of human interdependence and the need for structural approaches to mental health problems. Even before the arrival of the virus, American life was stressful and difficult due to the country’s terrible labor laws, underdeveloped welfare state, and regressive tax code. All but the ultra-rich were forced to live with high levels of very justified anxiety, knowing that one misstep or stroke of bad luck could leave them with nothing. Americans unable to find a place in the economy sank into despair, addiction, and suicide. And Americans struggled to maintain healthy relationships without adequate time off from work to raise children or just relax among loved ones. The arrival of Covid may have, as we love to say, started a conversation about these problems in the corporate media ecosystem, but the problems themselves have been festering for decades. And anyone seriously concerned with addressing them needs to look beyond individual solutions and toward treating the entire society.
This is not a novel proposition. There is a public health concept called “social determinants of health,” which refers to trends at the societal level that influence health outcomes at the individual level. For example, there are high levels of type II diabetes in poor communities. Like mental illness, type II diabetes is chemical in the sense that its cause is, technically speaking, related to a body’s inability to produce or process insulin. However, the risk of type II diabetes is increased with a poor diet and lack of exercise. And poverty almost categorically prevents people from having the time or money to eat nutritiously, get adequate exercise, or otherwise care for their bodies.
I suspect the reason this type of structural analysis isn’t more popular is that it makes demands that are decidedly unpalatable to supporters of American capitalism. Plus, it doesn’t make for particularly clicky articles. Once one comes to the conclusion that mental health problems are structural, not individual, one must then propose solutions in the same vein. If the problem is that people are stressed because they don’t have enough money, then it follows that wages should be raised and wealth taxed to more equitably distribute profits. If people don’t have enough power in the workplace, perhaps sectoral unions are in order. If people are anxious about paying for health care, perhaps we should have Medicare for All. If people are overworked, perhaps there should be a federal mandate that all workers must receive five weeks of paid vacation, as France has. The purpose of the Covid self-help genre, then, is to quell dissent by way of telling people that they can figure out how to cope all by themselves (or perhaps with their therapist, should they be lucky enough to afford one). It’s incredibly patronizing.
The Wall Street Journal article that suggested wearing work clothes to work from home—or any number of stories just like it—was attempting to address a widespread problem: people can’t focus. The reason people can’t focus is because they are stressed out. Their brains are producing a lot of cortisol, which interferes with memory and attention. A social determinants of health approach would ask why people are so stressed to begin with, and then focus on finding solutions that address the root causes of this stress.
Primarily people are stressed about money. They are stressed, perhaps, because they hate their job—which may have come to feel newly pointless in a pandemic. And they are stressed because their job—pointless or not—might vanish in an instant, plunging them into a slack labor market. In the United States, the stress of losing a job is largely the stress of losing a precarious grip on material stability that isn’t guaranteed by any other means. If you lose your job, you lose your health insurance, unless your spouse (should you have one) is fortunate enough to have employment-based health insurance of their own. You probably can’t afford to make your rent or mortgage payments, which puts you at risk of eviction and homelessness. After that, it is very difficult to get back on your feet.
Were we to take a social determinants of health approach to this problem, our solutions would probably not include telling people to wear a nice shirt on a Zoom call in order to quiet their fears. Our solutions would almost certainly include the issuance of monthly, living-wage stimulus checks to all Americans for the duration of the crisis, instead of a one-time $1,200 payment for people making under $99,000 a year; or an unemployment insurance policy would provide generous, easy to obtain, guaranteed payments, instead of fluctuating at the whims of an indifferent legislature; or rent cancelation so that tenants are relieved from the burden of rent and the growing burden of months of back rent. There is no shortage of social policy—Medicare for All, cash welfare, free childcare—that would do much the same. But such policy solutions are often seen as outside the realm of “mental health.”
Finally, one of the biggest psychological problems stemming from the pandemic feels almost too obvious to state. With 200,000 and counting dead in the United States, many more people are grieving the loss of parents, children, siblings, partners, and friends. Even for those fortunate enough not to personally know any of the Covid casualties, there is still the pervasive trauma of mass death and government indifference.
This trauma itself needs addressing. In order to do so, the federal government should hire thousands of mental health professionals to meet the nation’s skyrocketing need for treatment. This would act as a needed economic stimulus as well. And of course this care should all be free at point of use under a Medicare for All plan that includes a full range of mental health services.
Which brings me back to the Maslow meme. When I look at it, I see evidence that psychology did not always approach the mind as a discrete, walled-off entity, easily managed with a few hacks. I see also the direction the field of mental health must take, especially in a time of widespread crises. Anything short of economic and political reform will mean more psychological suffering. And any psychological solutions that target the individual will be only palliative. Don’t we deserve cures?