Anxiety, Stress and Depression in Macedonia – or how neoliberal capitalism turns its symptoms into profit

Lorazepam pills. From the “Lorzepam blog,” berritou.strefa.pl

“…As it happens, the whole internal tragedy of capitalism consists of the fact that at the time when this objecive, i.e thing-orientated psychology of man, which contained within itself infinite potential for mastery over nature and development of his own nature, was growing at a fast pace, his actual spiritual life was degrading and went through the process, which Engels depicts as the crippling of man”, Lev Vygotsky

The quest for economic growth, understood as not more than the rise in GDP, has become the foremost measure on the basis of which progress or decline in neoliberal capitalist societies is assessed. Other measures are subordinate to this; and their value is considered only in relation to it. That Macedonia’s GDP is projected by the World Bank to rise from the current 1,5% (2017), to 3,9% by 2019, can hardly be a cause of optimism. It offers no indication of a corresponding rise in society’s well-being. In fact the opposite is often the case, as profit made from society’s ill-being contributes to a rise in GDP measures- for instance when “goods” and services that “target” society’s pathologies rise in demand and profitability. Examining the manifestations of daily capitalist life such as anxiety, stress and depression, can give us an idea of society’s well being. Moreover, analyzing the responses available to such “maladaptive behaviors” can give us an indication as to how these become not only maladies of neoliberal capitalism, but also their profitable ventures.

A New Yorker cartoon by Drew Dernavich.

The month of November has been dedicated to mental health. As part of it, the Association of Psychologists of Macedonia organized a series of events under the title “A care for the self is a care for yourself”. The series proclaimed aims have been “to raise awareness of the importance of the psychological state of the person” and to affirm the profession of psychology as the “guardian of mental health”. More than naivety, these aims reveal the futility and oftentimes even the counterproductive nature of psychology in the context of Macedonia’s neoliberal capitalist society. Namely, psychology’s focus on individual responsibility and individual awareness, leads to a focus on treating the symptoms (such as depression, panic or anxiety), whilst the social and material causes, which often stand behind such mental conditions, are obscured in the process. As a result, mental illness seems to be constantly on the rise, with psychology (and psychiatry) unable to keep up or respond to it adequately.

For instance, figures from the Institute for Public Health demonstrate that in 5 years, from 2010-2015, the number of clinically depressed people has risen by 37%. In 2016, 55,000 patients were recommended to a higher medical examination, or recommended to receive a prescription for depression. That is around 2,75% percent of the entire population, not taking into consideration those that have failed to request medical assistance. The latest study by the same Institute indicates that 32.5% of all adults took sedatives or tranquilizers at least once in the past year. [The prevalence was highest in the age group 55-64 (52,3%), 39,3% amongst women and 28,1% amongst men].

The most obvious “options” available to Macedonians for treating depression, anxiety or stress range from exercise and self-help motivational psychology, to food supplements and even fortune telling.  What they have in common is that they all profit from mental instability and fragility.

By David Sipress, New Yorker.

The highest profiteer from mental illness is by far the pharma industry. One of the most prominent adverts on the most popular media in the country- the media aggregator www.time.mk – is for the tablets Lunerba from the Macedonian pharmaceutical company Alkaloid- a food supplement, which is said to “contribute to a normal functioning of the nervous system, normal psychological functions and reduction of fatigue and tiredness. It contains ingredients to reduce the symptoms of stress”. This is only one in a myriad of examples of how the food supplement (or more broadly pharma) industry profits from its promise to tackle the symptoms of “mild” nervous disorders.

According to figures from the Fund for Health Insurance of Macedonia (FZOM) in 2016, 3,37 million prescriptions were given for treating depression. “Diazepam”, a prescription medicine for the nervous system is the most sought after and consumed medicine in the country. In 2016, 216.024 insured persons bought it from on a prescription. Considering that the country’s population is less than 2 million this means that at least every 10th person has been using at least this medicine. The figures are even more staggering when taking into view that the figures from the Fund for Health Insurance only include medicines that have been bought in pharmacies under prescription, and do not list those medicines that have been bought privately.

The availability of a myriad of other prescription and non-prescription medicines such as bromazepam, helix and sanval, which are likely to cause addiction, only adds to an already highly worrying trend. Young people are highly susceptible to this trend. According to a report published by the Institute for Public Health every 10th teenager takes sedatives. With multiple stories appearing of anxiety disorders and depressions amongst teenage pop-culture role models this surely also contributes towards the acceptance of social anxiety, depression and even more severe mental illness as an inevitable part of living in the contemporary times- causing it to be considered as the new “normal” or usual.

FZOM has repeatedly confirmed that the use of anxiolytics and hypnotics is on a rising trend. However, failing to address the root causes of the problem, it has focused on highlighting its impact to the “health of the nation, the lessened workers ability and the absences from work in view of the counter indications caused by these medicines”. In response, a familiar response used every time when something is not working in public health- has been used also in the case of the mental health prescriptions- to blame it all on the doctors. Although systematic and scientific research has not been done to confirm this, media reports sometimes circulate the belief that one of the reasons is psychiatrists’ use of prescriptions as a first choice of treatment.

One recent news item states:  “Unfortunately here psychiatrists more often than not prescribe medicines instead of using so-called behavioral methods for treating the patients, or using conversation to reveal the causes of the psychological problem and offer counseling in order to surpass it”. This question demands serious research to establish the true ratio between prescriptions on the one hand and other methods on this other. Moreover, any such research over the question of psychiatrists’ possible tendency to prescribe medicines has to be placed  in the context of the broader question of the public health in the country.

By William Walsh, New Yorker.

Due to the scarcity of doctors, which also affects the mental health professionals, the ratio of patients per doctors is very high, with limited time available for adequate treatment of patients on a case-to-case basis. What is more, the low wages available in public health for medical professionals leaves them in a highly precarious position, that often allows ample space for potential influence by pharmaceutical companies that are likely to incentivize the prescribing of their products, either through marketing, or through co-optation by offering different types of rewards.

“Positive” psychology

Macedonia has not remained immune to the broader trend of “positive psychology”. Positive psychology is the method which conceptualizes happiness as a personal potential that is achieved by producing and managing thoughts that bring about positive emotions. Recommendations for how to purposefully and willfully command positive thoughts and emotions, and to repel negative ones, appear in all sorts of platforms. They are visible in online portals, where they feature in a myriad of Internet articles as some of the most popular content; in magazine and book racks in supermarkets and bookstores and on TV as part of motivational talks.

“Positive psychology” sells, but its effects are questionable at best. At worst, it can have highly negative social effects. As stated by Sugarman in his article Neoliberalism and Psychological Ethics: “Reconstituting happiness as an individual project, and a product of individual effort that can and should be controlled, means that individuals are even encouraged to extricate themselves from social relationships that can threaten such control. As a result, commitments and responsibilities to others, preoccupation with the judgment of others, social cohesion and collective responsibility all come to have a pejorative connotation as a potential threat to individual happiness”

Besides being a profitable venture, food supplements, medicines and positive psychology share another feature. They focus on treating the symptoms (such as depression and anxiety) instead of the often social or material root causes behind mental conditions. What is more, by offering an immediate relief, they ameliorate the symptoms, but they do not cure them, in the process leading people to gradually adjust, ignore or even start considering as normal the conditions that caused their stress, anxiety or depression. Furthermore, the combined effect of all these “options” for treating mental instability is the focus on individuals, and the failure to examine the social aspects of psychology. When social anxiety and depression are considered a pathological disorder internal to individuals, that need to be medicalized or treated by positive thoughts, it can be argued that this in fact encourages conformity to neoliberal capitalist ideals that may in fact in the long run exacerbate rather than alleviate people’s difficulties.

As Sugarman correctly concludes, one of the results of this tackling of symptoms instead of (socio-political and materials) causes behind them, is that it diverts from taking up collective social and political concerns and democratic practices as citizens engaged with others. As a result, the sociopolitical status quo goes largely unexamined and unquestioned. What this implies is that psychology as well as psychiatry needs to become more social, to pay due attention to the multitude of social psychological implications of neoliberal capitalism. Until (social) psychologist and psychiatrists play a more active role in highlighting the mental/psychological implications of the socio-political system they will remain passive victims, but also inadvertent agents of neoliberal capitalist ideology.

Another New Yorker cartoon, by Lewis.

Adela Gjorgjioska is a PhD candidate in Critical Social Psychology, at Sapienza  University. She is a member of the Social Center Dunja in Skopje, as well as the leftist movement Solidarnost.