The radical politics of madness: An interview with Micha Frazer-Carroll

Micha Frazer-Carroll, a prolific writer, editor, and advocate, delves into the radical politics of madness, mental health discourse, societal power dynamics, and disability justice.

A columnist for the Independent, and a former editor with the Guardian and gal-dem, she also founded Blueprint, a magazine exclusively dedicated to mental health issues. Frazer-Carroll has emerged as a formidable voice in challenging the orthodox, often apolitical, interpretations that pervade psychology and psychiatry.

Her new book, “Mad World: The Politics of Mental Health,” released by Pluto Press, is a rigorous dissection of mental health as a profoundly political issue. In its pages, she situates our understanding of mental health within the larger constellations of capitalism, systemic racism, disability justice, and queer liberation, among other frameworks.

“Mad World” is a revolutionary manifesto, probing into the possibilities of empathic care and a reimagining of what we mean by mental well-being. Critics have lauded it as a “radical antidote” to the prevailing paradigms that dictate our attitudes toward mental health. It serves as an indispensable primer for those seeking to subvert the status quo in their respective fields.

In this interview, we engage with the intricacies of “The Radical Politics of Madness” and explore what it means to reframe mental health as an urgent political concern. We discuss the potential of radical political thought to liberate us from the restrictive lexicon and institutional constraints that often encase our understanding of mental health.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Justin Karter: I think it is helpful to begin by discussing what we mean when we talk about the politics of mental health. Many attempts to connect mental health, mental distress, and madness to political realities connect the material effects of poverty, oppression, and dislocation to the development of psychological disturbance. However, you deliberately push beyond this approach. You write that “a truly political approach cannot only look at causes of what we call madness and mental illness. It must also be constructivist – interrogating the very concepts of madness and mental illness themselves…” Can you begin by explaining your approach here and how being constructivist illuminates the political complexities of mental health work?

Micha Frazer-Carroll: Definitely. So I should start by saying that I think it is really crucial, as you mentioned, to situate mental health and our experience of distress within a political context. We must ask how forces like neoliberal capitalism, racism, homophobia, transphobia, and ableism shape who experiences distress and how it is experienced. I believe that’s really important.

But as you mentioned in the book, I try hard to push beyond just asking, “Why are some groups disproportionately likely to experience mental distress?” Instead, I ask, “What is this thing that we call madness or mental illness, and how did we come to think of it this way?” The reason I think this inquiry is necessary for a radical political approach is that when we start to question and examine the history of when certain things became categorized as madness or mental illness, we see that political forces, explicitly capitalism, play a significant role in defining who is seen as mentally well or ill, and who is seen as mad or sane.

Unless we examine these political conditions and explore how we came to define the things we call madness and mental illness as such, I think we can’t truly take a political approach. We must unpack and ask, “Could it look a different way in a different world?” and “Is the way all of the people that are usually categorized societally into these groups consensual, and is it actually good for them?” That’s why I believe a political approach demands this focus on the social construction of these concepts.

Karter: So you’re pointing out the fact that the very language we use, the words like “madness,” “mental distress,” in the mental health fields, each contain within them a lot of ideological, philosophical, and historical baggage. In the book, I see you both working within the existing language—because that’s what we have—but also trying to challenge it and create new ways of talking and thinking. For example, you make a point of talking about “bodyminds” as one word. Can you tell us what this means and how it challenges our usual discourse and our ways of thinking about the mind in mental health?

Frazer-Carroll: As you say, language is so potent in this area, and I really agonized over the use of certain terminology. Much like “Mad In America,” my book is called “Mad World,” and “madness” is right there in the title. But to some people, that’s seen as controversial. At the same time, “mental illness” comes with a lot of baggage and ideology that’s woven into that concept. I use the term “bodyminds,” which you point out, and it’s another one that I agonized over. At first, I thought it might sound too jargony, but then I decided to go with it. The use of the word “bodyminds” unites “body” and “mind” in one word, trying to gesture towards the idea that we often think of the mind as a completely separate domain from our physical bodies. This separation is rooted in Mind-Body dualism, the idea that they’re not intertwined. I wanted to push against this for several reasons.

I think one reason is that even in the critical mental health space, I sometimes see evidence of this dualism popping up when people say things like, “Mental health is constructed, but physical health is real,” or “Diagnosis isn’t valid for mental health, but is for physical health.” I tried to muddy the waters a bit by saying “bodyminds,” and gesture towards the fact that not only psychiatry but also the medical industrial complex, all our ways of thinking about biomedicine and diagnosis, for example, are grounded in a political context. I think when we analyze the mind and the body, or psychiatry versus medicine, we need to acknowledge that there’s a lot of fluidity between the two, and there’s not a hard split between them.

Karter: In the book, there was a quote that stuck out to me where you said that illness—and I think you’re alluding to both physical and mental “bodyminds”—illness is a way of being or an identity necessitated under capitalism. Something to that effect; is that right? Can you elaborate on what you meant by that?

Frazer-Carroll: Yeah, I borrowed this from the Socialist Patients’ Collective, which was a psychiatric survivor and service user collective operating, I believe, in the 1970s in Germany. They have this manifesto called “Turn Illness Into a Weapon,” which has some really intriguing analysis of mental health under capitalism, but also health and illness more broadly. They take this united approach, probably advocates of the body-mind idea, when they talk about mental and physical. They write that illness is unnecessary; it is the only condition that we can have under capitalism, which I think is really apt.

This theme comes through quite a lot in the book, looking at how, for example, the Industrial Revolution caused not only mass distress, leading to the explosion of the asylum system during this period, but also physical injuries on the production line, people getting sick in crowded city conditions, and so on.

So the concept really is that capitalist work, along with the quest for profit and capital accumulation more broadly, will always harm us; it will always make us sick. How unwell you become, or how much you suffer, is a matter of degree. We’re all experiencing the same forces to an extent.

Karter: You make the compelling case in your book that our current understanding of mental health and madness has been inextricably tied to the demands of capitalist production from the start. For example, you cite laws adopted in the UK in the 1800s that attempted to name and manage the conditions preventing people from living independently and working in factories. Previously, these folks were able to be part of communities and families, contributing in ways no longer seen as employable labour, but now they needed to be named and accounted for. Can you elaborate on how mental health and mental illness have been tied to ideas of productivity under capitalism?

Frazer-Carroll: Definitely. As you mention, I take a U.K. focus in the book, starting with Bethlem Hospital, colloquially named Bedlam, the world’s first known asylum. I examine the fact that in Britain, for the majority of history, people categorized as mad lived in the community, cared for by family or friends. For example, the poor laws were introduced in Britain, stripping funding from families who previously could afford to care for their mad relatives at home. I also consider the dawn of the capitalist economic system and the Industrial Revolution, which coincided with the poor laws, and the shift from community-based production to fast-paced factory conditions.

I explore this emergence of the factory as a key moment in starting to categorize particular people as mad and in starting to institutionalize them. The number of admissions to asylums exploded around this time. A few reasons for this include the stripping of family funding and the need for people to go to factories or workhouses instead of working at home. This shift from a community-based approach to care resulted in many more people being admitted to asylums. In Britain, two asylum acts were passed, mandating the building of what were called Lunatic Asylums in every county.

Many people question why so many were suddenly admitted, and I believe the emergence of capitalism is a key factor. With so many admissions, you see systems of taxonomizing. Initially, there were two main categories, Mania and Melancholia, but over time, narrower and even ridiculous categories emerged, such as politics, novel reading, and immoral life, all considered valid forms of madness. This illustrates who in society was seen as productive.

I argue that those sent to asylums, categorized as mad, were seen as unproductive. They couldn’t work on the production line or be cared for at home. As the book progresses, I extend this argument to how we categorize mental health versus illness today. For instance, Bruce Cohen notes in “Psychiatric Hegemony” that the DSM mentions work 300 times. Work is central to judging what’s considered an illness. The ability to work is a major factor in diagnosis, even to the point where meeting deadlines might negate a diagnosis of depression.

On the flip side, some experiences, such as hearing voices, are pathologized even if they’re not distressing because they’re often associated with a reduced ability to work a traditional job. I try to question whether we could create a world where work isn’t the central metric by which we value people’s bodies and minds. I argue that we should build toward a future that’s more self-directed and less characterized by capitalism.

Karter: You highlight the need to function under specific capitalist conditions that require self-management and hyper-individualism, and you connect this to neoliberalism and the necessity for people to manage their emotions independently. This concept is further tied to how people navigate the world. In your book, you discuss the role of psy-professions in neoliberalism, suggesting that thinking in mental health terms might weaken resistance to capitalism. You note that strike days have dwindled over recent decades while working days lost to stress-related illnesses have surged. You also plainly state that mindfulness is no substitute for a unionized workplace. Can you elaborate on how mental health discourse, psychiatry, and psychology may have played a role in the weakening of labour politics in the U.K. and the U.S.?

Frazer-Carroll: I certainly think it has played a role and intertwined with the diminishing of labour politics. As you mentioned, journalist Tim Adams points to a peak in mass strike action in the UK during the 1970s. This was followed by a dismantling of the labour movement under Margaret Thatcher, and at the same time, the number of days workers lost to “stress-related illness” increased dramatically. Though it’s anecdotal, it illustrates a shift from diagnosing the problem as societal to viewing it as an individual concern. What might have been perceived as a societal disorder becomes an individual one. Cultural theorist Mark Fisher refers to this as the privatization of stress. Under neoliberalism, we see the privatization of many state services and businesses, and Fisher argues that even our perception of stress and political problems has shifted to an individual level.

I do have sympathy for the workers losing days to stress-related illness. This is a very real problem, and policies like those enacted by Margaret Thatcher that targeted the union movement contributed to this situation. However, I also think that we must question our response to these issues. Often, mental health treatment becomes about realigning what are seen as unruly individuals with market demands. This approach is both individualistic and retrospective.

What’s insidious is how this approach has permeated workplaces. Many people can now get free therapy or mindfulness apps through their work, and while these remedies can be helpful to some, they are inherently individual. By beginning and ending our analysis at the individual level, we never reach the political core of the problem. It also leads to blaming individuals for suffering caused by our economic system.

A British service user collective, Recovery in the Bin, aptly named, points this out. They argue that the individual recovery model adopted by services is flawed. They insist that under current conditions, full recovery may be impossible for some, and pretending otherwise places blame on individuals for problems they didn’t create.

Karter: So it appears that mental health discourse – not just mental health treatment itself, but how psychological constructs spread to become a discourse that people use to make sense of themselves – serves two functions under capitalism. One function is to identify and isolate those who can’t function within the system and those who won’t be productive and find a way to move them out of the labour market. The other function is a sort of recovery process that helps cultivate people to be the types of subjects that can continually show up to work the next day, even if it is alienating, extracting, or causing illness, as you say. It thus prepares the labour market to be exploitable under capital. 

This is particularly interesting to think about in light of the global mental health movement, as it seems to spread this discourse globally, preparing subjects from different cultural backgrounds to be used. Could you say more about the global mental health movement and how ways of thinking about ourselves – or even ways of experiencing spiritual practices, as you mention – can be categorized and treated as pathology? How does this impact populations globally when we’re spreading this particular neoliberal Western mental health discourse?

Frazer-Carroll: Yeah, in the book, I draw on the work of Dr. China Mills to critique the Global Mental Health Movement, which essentially exports psychiatric ways of thinking across the world.

I examine various examples to understand how psychiatry operates cross-culturally. For instance, I look at a proposed diagnostic category in the 19th century called Drapetomania, proposed by a physician named Samuel Cartwright. The symptoms were when enslaved Black people would run away from the plantation, and the prescribed treatment was beating or whipping. We can now see this as ludicrous, but it reveals what was expected of Black people at the time to make them exploitable.

One clear modern-day example comes from my experience with my communities and my family in Antigua and Jamaica. In Antigua, my family was involved in the Pentecostal church. In that context, spiritual experiences like hearing the voice of God or speaking in tongues were not only tolerated but encouraged. This is significant when considering the disproportionate number of Black people diagnosed with schizophrenia. While racism and trauma may play a part, we must also examine the construct of the diagnosis itself and recognize that specific populations may be disproportionately diagnosed.

In the book, I also discuss the stereotyping and construction of schizophrenia in line with ideas of criminality, with terms like “hostile” and “aggressive” in the diagnostic criteria. This can’t be separated from the fact that Black people, and Black men specifically, are disproportionately diagnosed and also stereotyped as hostile, criminal, and aggressive. I try to look at how exporting diagnosis across racialized populations and across the globe leads to marginalized and global majority people being pathologized in unique and disproportionate ways.

Karter: You’ve emphasized the widespread suffering in communities and the need to be cautious with the language used to describe it, avoiding a solely Western, neoliberal view. This leads me to consider the different interpretations of mental distress within various mental health fields and among activist and identity groups. In your book, you propose a more inclusive approach, focusing on the diverse ways people experience and describe suffering. You suggest this could foster solidarity among groups such as those identified as mad, neurodiverse, neurodivergent, psychiatric survivors, or psycho-socially disabled, and others opposing mainstream views. Could you elaborate on this epistemological approach and explain how it might facilitate unity among these different groups?

Frazer-Carroll: The argument I made in the book was indeed risky, as it’s a contentious issue. Questions like “Is it an illness? Is it society? Is it distress? Is it all capitalism?” are personal and often controversial. These topics can become heated in mental health and mad spaces. Like you mentioned, I draw on the work of Jonah Bossewitch from the Fireweed Collective, arguing that the heart of the matter may not be about finding an objective truth, such as whether it’s biological or social. Instead, I believe in many possible realities where people can have autonomy over how they define their experiences without being non-consensually pushed into specific frameworks or languages.

What I find insidious about psychiatric knowledge is how it’s presented as objective, like all medical knowledge. I believe in the validity of lived experience, and survivor knowledge, and that there can be many possible truths. Your suggestion about trying to come together and find solidarity resonates with me. Conflicts can arise, for example, between the neurodiversity movement, which often reclaims psychiatric language, and the psychiatric survivor or mad movement tradition, which generally rejects this terminology. I hope for a future where we can unite these perspectives, creating a coherent politics that resists psychiatric power, allows creativity with language, and emphasizes survivor agency. Whether we use terms like mad, mentally ill, neurodivergent, or psychosocial disabilities, the central principle should be our agency over how we define ourselves.

Karter: This aligns with my research into psychosocial disability, a construct that different activist groups are using to unite, discuss, and resist mental health discourse. One consistent result I found was an agreement not to challenge each individual’s definition of how they became different, neurodiverse, or mad. They recognize that society’s labelling or exclusion based on that difference created the disability, discrimination, or inability to fully participate in life. Despite various understandings of the origin, there was an ability to unite to fight against the conditions that produce disability among those struggling. Do you see psychosocial disability as a potential umbrella term or a philosophy that can unite these different groups?

Frazer-Carroll: Well, firstly, I want to expand on what you just mentioned, because it’s very relevant. It links to the notion that we often feel a need to find the cause or origin of mental differences. This can be seen as a psychiatric, medicalized, or scientific approach—seeking a blood test, brain scan, or objective measure. I’m arguing, like you, that madness, mental illness, or disability operates as a social experience. As for psychosocial disability, I think it could be an effective bridge, recognizing the possibility of both or an interaction between various factors.

Also, I appreciate the use of the word “disability,” as I have a constructivist and social model approach to it. This acknowledges that disability isn’t an inherent biological fact but is instead about societal conditions that hinder participation. I like the term because it leaves space for this approach, recognizing that disability is not inherent but constructed by our living conditions. Simultaneously, I know that for some, the term “disability” might be difficult to claim or reclaim, perhaps due to existing marginalizations or the fear of increased stigma. There are debates around this word, but for me, it’s a term that I find fitting and appealing.

Karter: I’m trying to think about how we can move beyond these terms, a task I find difficult even in this conversation, as we strive to discuss these issues without invoking mental health discourse. It’s always lingering in the background. But you end the book on a hopeful note, outlining several alternatives to the status quo that could revolutionize our approach to madness. Going further, you push us to envision a world beyond the psychiatric discourse we’ve all inherited. So, first, I want to ask you, what alternatives give you hope? What stood out in your reading and research? Secondly, what might a world look like where we can think beyond and without this psychiatric discourse?

Frazer-Carroll: Yeah, I want to emphasize that there isn’t a single answer, project, or example that can solve everything. The future of mental health must be plural, relying on millions of unique, hyperlocal, tailored experiments, rather than a one-size-fits-all approach like psychiatry tries to be.

A few examples that I love include the Hearing Voices Network, which takes a de-pathologizing approach to experiences like hearing or seeing things others don’t. Instead of simply eradicating a symptom, usually with psychiatric medication, they explore engaging with the content of voices, finding different ways to relate to these experiences. It’s not about reframing them as positive or good; there are various ways to approach them.

I also appreciate Mad Pride, which represents a liberating, de-pathologizing way of thinking about madness and distress. The resurgence of Mad Pride in the UK and the campaign for psychiatric abolition show that it’s possible to acknowledge the reality of suffering while also taking pride in madness as an identity.

Furthermore, initiatives like Crisis Houses and peer support, especially non-carceral crisis interventions in the States, excite me. They emphasize community and individualized approaches.

For me, a liberated future also means a world where far fewer people reach a crisis point in the first place. We need to move away from institutions, but that alone is not enough. We must also transform the world and the conditions that produce these institutions, creating an environment where fewer people suffer and communities have the resources to care for one another before they become unwell.

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Editor’s note: this article originally appeared on our sister site Mad in America, and is shared with permission here

Cover image credit: Edi McGurk