Tag: health

A Social History of Sickness Before Modern Medicine: On Jennifer Evans and Sara Read’s Maladies and Medicine

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Jennifer Evans and Sara Read’s Maladies and Medicine: Exploring Health and Healing, 1540–1740 (Pen & Sword, 2017) appears, at first glance, as a concise social history of illness in early modern England. However, when viewed within a wider context of social reproduction and class formation of that era, the book reveals more: it offers insights into how bodies were regulated, how suffering was accepted as natural, and how the rise of capitalism transformed the conditions in which ordinary people lived, worked, and died.

Evans and Read do not aim to write a comprehensive history of class or the shift to capitalism. Instead, they use an empirical, descriptive approach organised around specific ailments rather than overarching arguments. The evidence they compile—such as casebooks, diaries, court records, household remedies, and cheap almanacks—provides valuable insights into how sickness operated within a society experiencing significant change. Their book inadvertently but effectively captures the medical aspect of the gradual decline of feudalism and the emergence of capitalist social relations.

The Humoral Body as a Social Body

The authors focus on the humoral body, viewed as a delicate balance of hot, cold, wet, and dry forces, constantly threatened by diet, weather, labour, and morality. This concept extends beyond medicine into a social worldview, making sense in a setting where most people lived on the brink of subsistence, faced endemic malnutrition, endured physically demanding work, and where environmental factors were linked to social class. Evans and Read interpret humoralism as a belief system, while a materialist perspective considers it a form of ideology.

Humoralism reframed structural suffering as personal imbalance, attributing disease to personal regimen, moral failure, or the mysterious flow of fluids rather than factors like enclosure, dispossession, or wage labour. This served an ideological purpose by naturalising the suffering created by the rise of capitalism.

The Medical Hierarchy and the Restructuring of Social Reproduction

The book’s strength lies in its detailed portrayal of the layered medical economy. It highlights university-trained physicians at the top, whose Latin education and guild privileges attracted wealthy clients. Below them, apothecaries and surgeons handled manual, often bloody treatments. Further down was a large informal sector of unlicensed healers—many women—whose inherited household knowledge served most of the population. Evans and Read describe this hierarchy, but within early modern social reproduction, it indicates a deeper underlying process.

Women were excluded from formal medical authority not just due to prejudice but as part of a broader process of knowledge enclosure. As capitalist relations grew, household and community-based care—largely performed by women—became subordinate to professional monopolies. This shift in the medical field reflected similar changes in reproductive labour, such as midwifery, childcare, food preparation, and sickness management, which became battlegrounds between traditional communal practices and emerging market influences. The ‘informal economy” of healing was not merely an outdated relic; it was the leftover of a pre-capitalist social reproduction system actively being dismantled by the new economic order.

Disease, Poverty, and the Making of a Proletariat

Evans and Read briefly mention that factors like poverty, overwork, and malnutrition influenced who became ill and who received treatment. However, they do not link these issues to the class relations of early modern England, which a materialist analysis would require. Between 1540 and 1740, England experienced significant social and economic changes, including the enclosure of common land, the dispossession of peasants, the rise of wage labour, increasing urban poverty, and the emergence of a landless proletariat.

These processes not only created new economic relationships but also established new physical conditions. “Bad diet” and “corrupt air” were not simply random misfortunes; they reflected the lived reality of class identity. The illnesses listed by Evans and Read—such as plague, smallpox, gout, toothache, and madness—were unevenly distributed based on property ownership and labour roles. The ailing body was inherently a body defined by class. Later, Engels would describe this as “social murder”: the deliberate, systemic creation of disease and early death through societal organisation. Evans and Read’s era can be seen as the groundwork for this concept—the period during which the foundations for social murder were established.

What the Book Offers—and What It Cannot Provide

As a compendium of lived experience, Maladies and Medicine is invaluable. Its prose is clear, its sources rich, and its case studies vivid. It allows the reader to encounter sickness in something close to its own terms.

But as an explanation of why early modern medicine took the form it did, the book is incomplete. It catalogues belief and practice but does not analyse the social relations that produced them. It describes the medical hierarchy but does not explain its connection to the restructuring of social reproduction. It notes poverty but does not treat it as a structural determinant of disease.

Where the book falls short is in its reluctance to press this material toward a fuller social explanation. Poverty, overwork, malnutrition, and environmental degradation appear in the narrative, but only as background conditions rather than as structuring forces. The authors note that “bad diet” and “corrupt air” shaped who fell ill and who could be treated. Still, they do not connect these phenomena to the concrete class relations of early modern England—the dispossession of the peasantry, the growth of wage labour, and the emergence. The text discusses how a landless proletariat lives on the brink of subsistence. It emphasises that the authors’ limitations are more about the academic division of labour than about their failure. The history of medicine is often viewed separately from class struggle, ignoring the interconnectedness of bodies and social structures. Maladies and Medicine offers a solid empirical base for a Marxist perspective on early modern social reproduction, illustrating how the shift to capitalism impacted not just work and courts but also kitchens, sickrooms, and individual bodies. It successfully recovers and documents these aspects but leaves broader explanatory questions about societal forces open for others.

The Anglosphere’s Mental Health Crisis and the Social Catastrophe of Capitalism

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Recently, a new wave of commentary has surfaced trying to account for the rapidly worsening mental health crisis among young people in advanced capitalist nations. One notable analysis is by Financial Times columnist John Burn-Murdoch, who uses various data sources to show that the crisis is primarily concentrated in the Anglosphere—comprising the United States, Britain, Canada, Australia, Ireland, and New Zealand. His charts and graphs are presented as a calm, fact-based contribution to a debate often viewed as inflated by exaggeration and moral panic.

However, like many mainstream analyses, Burn-Murdoch’s discussion ends right where the deeper explanation starts. He highlights symptoms but avoids diagnosing the underlying problem. His perspective is limited by the ideological beliefs of the capitalist system, preventing him from confronting the social reality that millions of young people are being mentally overwhelmed by a system that makes a decent and secure life impossible.

The Limits of Bourgeois Explanation

Burn-Murdoch’s main argument — that the crisis originates from “shattered homeownership expectations” — exemplifies bourgeois reductionism. This narrative suggests that young people were brought up to expect to own property, and the housing market’s failure to meet these expectations has led to widespread despair.

This argument diminishes a serious social crisis by framing the suffering of a whole generation as simply unmet consumer expectations. It suggests that lowering mortgage rates or fixing the housing ladder would eliminate the crisis. This perspective is not only insufficient but also ideological, as it assumes capitalism is inherently stable and that the issue stems solely from unequal distribution of rewards.

The truth is quite different. The housing crisis is not a separate failure but a sign of the ongoing impoverishment of the working class. As an analysis from WSWS pointed out years ago, the dream of owning a home in America has become out of reach for many young families due to declining wages, increasing expenses, and exploitative lending practices — not because capitalism has failed, but because it is operating precisely as intended.

Mental Illness as a Social Disease

Mainstream commentators’ refusal to acknowledge social causes is deliberate, not accidental—it’s ideological. Over 25 years ago, the WSWS noted that the US Surgeon General’s report on mental illness acknowledged that “the precise causes of most mental disorders are not known,” yet it emphasised brain chemistry and genetics as the main causes. The WSWS pointed out that this choice was obvious: “Can anyone imagine the Surgeon-General of the United States issuing a major report declaring that the epidemic of mental illness in America is due to … American society?”

Acknowledging mental illness as a social disease implicates the capitalist system itself, raising controversial political issues about societal organisation, the dismantling of social protections, and the isolation of human life driven by profit motives. Burn-Murdoch, like others supporting the current system, is unable to go beyond describing the crisis; he cannot explain its underlying causes.

The Historical Evolution of Psychiatric Ideology Under Capitalism

The current mental-health crisis, affecting millions in advanced capitalist nations, is not just an outbreak of individual issues. Instead, it results from a long history where psychiatry has been influenced and manipulated by capitalism’s demands. Psychiatry is not a purely scientific field; it has developed alongside capitalism’s social relations, mirroring its contradictions, fears, and its primary goal to maintain the status quo. To fully understand today’s crisis, one must trace this development from the Industrial Revolution to its present-day neoliberal state.

Psychiatry’s Birth in the Age of Industrial Discipline

Modern psychiatry developed in the late 18th and early 19th centuries, coinciding with the consolidation of capitalism’s dominance over society. The growth of factories, wage labour, and urbanisation led to new forms of social dislocation and human suffering. However, the ruling class did not see these issues as signs of the harshness of early industrial capitalism. Instead, they were viewed as individual disorders.

The asylum, a core institution of early psychiatry, had two main roles. It separated those deemed “unproductive,” “irrational,” or “dangerous” and upheld norms of bourgeois discipline. The so-called ‘moral treatment’ introduced by Philippe Pinel and William Tuke was not truly moral in an emancipatory sense; rather, it was a system of surveillance, obedience, and labour aimed at shaping individuals into compliant members of the growing capitalist society. The ideological premise was clear: if individuals could not function within capitalist society, the fault lay within the individual, not the society.

Pathologising Deviance, Protecting Property

As capitalism developed in the 19th century, psychiatry broadened its scope. During the Victorian era, issues like poverty, alcoholism, “hysteria,” and political dissent became medical concerns. Women challenging patriarchal norms were diagnosed with “nervous disorders,” while workers protesting poor conditions were deemed unstable or criminally inclined.

The bourgeois family, regarded as the ideal core of capitalist society, was seen as the normal and healthy family unit, with any deviations viewed as abnormal. Psychiatry emerged as a tool for enforcing social conformity and upholding property relations. During this era, biological determinism and early eugenics gained prominence, offering pseudo-scientific backing for class structures and imperial rule. Mental illness was often depicted as hereditary, serving as a convenient justification for maintaining social inequality.

The Age of Social Crisis and Biological Reductionism

The early 20th century was marked by world war, economic depression, and revolutionary change. Millions of soldiers returning from the First World War exhibited “shell shock,” a condition that challenged the idea that mental suffering is solely individual. However, instead of addressing social causes of trauma, the ruling class reinforced biological reductionism. During the interwar years, treatments like lobotomies and insulin shock therapy emerged, reflecting a system eager to hide the social roots of widespread psychological crises, rather than genuinely improve patient care.

The Great Depression produced widespread despair, unemployment, and social disintegration. But psychiatry did not interpret these phenomena as consequences of capitalism’s crisis. Instead, it doubled down on individual pathology, reinforcing the ideological firewall between social conditions and mental suffering.

The Welfare State and the Pharmaceutical Revolution

After 1945, a period of temporary stability emerged. The welfare state, increased wages, and expanded social services helped reduce many of capitalism’s worst abuses. Psychiatry evolved accordingly, gradually phasing out asylums and introducing new psychotropic medications like chlorpromazine, antidepressants, and benzodiazepines, which offered chemical remedies for psychological issues. However, the ideological basis remained unchanged: mental illness was still seen as an individual malfunction. Systematic neglect of the social origins of suffering—such as alienation, exploitation, racial oppression, and gender inequality—continued to be a defining feature of psychiatric theory.

The pharmaceutical industry, embedded within the capitalist profit system, grew into a powerful force. Treatment was turned into a commodity, transforming the patient into a consumer. The role of the psychiatrist shifted to simply prescribing. These social conflicts were hidden behind the promise of quick chemical relief.

The Atomization of Society and the Explosion of Diagnosis

The late 20th century marked the rise of neoliberalism, characterised by deregulation, privatisation, union-busting, and the erosion of social protections. This led to increased societal atomization, causing unprecedented stress, insecurity, and despair. Psychiatric ideology adapted to this new environment, with the DSM expanding significantly to include more diagnostic categories and medicalising common distress. Conditions like ADHD, mild ASD, generalised anxiety disorder, and major depressive disorder emerged as widespread phenomena.

This surge in diagnoses was deliberate, fulfilling three political roles: it personalises social suffering, thus avoiding scrutiny of capitalism’s influence; it opens new markets for pharmaceutical companies; and it disciplines workers by framing distress as an individual flaw instead of a consequence of exploitation. During the neoliberal era, cognitive-behavioural therapy (CBT) also gained prominence. Designed to help individuals adapt to difficult conditions rather than change them, its main message—”change your thoughts, not your circumstances”—aligns closely with capitalist values.

Capitalism’s Social Breakdown and the Ideological Dead End

Today’s mental health crisis stems from forty years of social counter-revolution. Young people are burdened with unstable jobs, skyrocketing housing costs, declining public services, and broken community networks. The rise of the gig economy has undermined job stability. Market forces have dismantled social connections. The obsession with personal “success” and “failure” has become dangerously extreme.

Psychiatric ideology remains stuck in a framework from two centuries ago. It fails to recognise that capitalism itself fuels widespread psychological suffering and that mental illness is a social issue. Instead, it attributes distress to neurotransmitters, genetics, and personal problems, expanding diagnostic categories and prescribing more medication. It promotes “resilience training” and “mindfulness” as solutions for enduring conditions that should be eliminated. The ruling class relies on this ideology; without it, the social consequences of the crisis could be explosive.

Why the Anglosphere?

The crisis is concentrated in the Anglosphere for obvious reasons. These countries have seen the most extensive dismantling of the postwar welfare state, the most aggressive erosion of job security through the gig economy, and the most ruthless subordination of social bonds to market forces. Additionally, the ideology of individual “success” and “failure” is deeply rooted here.

Young workers in these nations face conditions not seen since the Great Depression. They face job insecurity, unaffordable housing, failing public services, and an inability to reach fundamental life milestones such as starting families or securing stable homes. A WSWS analysis of youth suicide pointed out: “The youngest generation of workers is entering adulthood in the wake of 40 years of social counter-revolution against the working class.” This issue isn’t just about unfulfilled dreams of property ownership; it involves the breakdown of the material and social bases necessary for a humane life.

The Medicalisation of Social Misery

Burn-Murdoch warns against the dangers of medicalising everyday distress, but he views this mainly as a technical issue of diagnostic accuracy. In truth, medicalising social suffering serves as a political tactic. It is a cost-effective and ideologically easy method for the ruling class to control an increasingly distressed population. When millions of children have trouble focusing, the cause isn’t blamed on overcrowded classrooms, exhausted parents, or economic insecurity. Instead, they are branded as neurologically disordered and treated with medication. Similarly, young adults overwhelmed by unstable jobs and high living costs are told their suffering results from chemical imbalances.

Decades ago, the WSWS cautioned that governments were increasingly using psychoactive drugs to control children’s behaviour, pointing out that British laws were so extensive that doctors could prescribe medication simply because children struggled with math or spelling. This was not a diagnostic error; it was intentional social policy.

The CDC Data and the Class Question

The CDC’s 2021 Youth Risk Behaviour Survey revealed that 42% of US high school students felt persistent sadness or hopelessness, 22% seriously considered suicide, and 10% attempted it. However, the CDC primarily interpreted these statistics through race and sexual identity, avoiding discussions of class. This omission is revealing: identity categories are politically safe, whereas class is not. Analysing the crisis through class would mean acknowledging that capitalism causes widespread psychological suffering, even for those who are housed, fed, and employed. As the WSWS pointed out, “When we finally reach a point where half the population can’t, at one time or another, function — who, then, is really sick: the individual or society?”

The Political Conclusion

Burn-Murdoch’s technocratic ideas—improving data, diagnostics, and policy targeting—are like rearranging furniture in a house on fire. They don’t address the root cause of the crisis. Under capitalism, mental health treatment is only emergency care: it patches psychic wounds so individuals can keep functioning in a system that caused their sickness. The mental health epidemic won’t be resolved through more therapy, medication, or affordable housing—though these may help reduce suffering. A true solution requires the working class to gain political power and rebuild society on socialist principles, prioritising human needs over private profits. As the WSWS concluded long ago: “Happiness can become a reality only if its human content is restored to it, and that means that the happiness of one is inseparable from the happiness of all.” This is not just idealism; it’s a political necessity.

Sources and Bibliography

I. Marxist Foundations: Alienation, Social Pathology, and Ideology

  • Karl Marx, Economic and Philosophic Manuscripts of 1844 (1844).
  • Karl Marx & Friedrich Engels, The German Ideology (1846).
  • Karl Marx, Capital, Vol. I–III (1867–1894).
  • Friedrich Engels, The Condition of the Working Class in England (1845).
  • Georg Lukács, History and Class Consciousness (1923).
  • Wilhelm Reich, The Mass Psychology of Fascism (1933).
  • Erich Fromm, The Sane Society (1955).
  • Frantz Fanon, Black Skin, White Masks (1952); The Wretched of the Earth (1961).
  • István Mészáros, Marx’s Theory of Alienation (1970).
  • David Harvey, A Brief History of Neoliberalism (2005).
  • Moishe Postone, Time, Labour, and Social Domination (1993).

II. Histories of Psychiatry and Social Control

  • Michel Foucault, Madness and Civilisation (1961).
  • Andrew Scull, The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900 (1993).
  • Andrew Scull, Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness (2022).
  • Roy Porter, Madness: A Brief History (2002).
  • Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830–1980 (1985).
  • Thomas Szasz, The Myth of Mental Illness (1961).
  • Nikolas Rose, Governing the Soul: The Shaping of the Private Self (1989).
  • Nikolas Rose, The Politics of Life Itself (2007).
  • Joanna Moncrieff, The Myth of the Chemical Cure (2008).
  • Irving Kirsch, The Emperor’s New Drugs (2009).
  • Anne Harrington, Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness (2019).

III. The DSM, Medicalisation, and the Pharmaceutical Industry

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, DSM‑I (1952) through DSM‑5‑TR (2022).
  • Christopher Lane, Shyness: How Normal Behaviour Became a Sickness (2007).
  • Allan V. Horwitz & Jerome Wakefield, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder (2007).
  • Peter Conrad, The Medicalisation of Society (2007).
  • David Healy, Pharmageddon (2012).
  • Robert Whitaker, Anatomy of an Epidemic (2010).
  • Carl Elliott, White Coat, Black Hat: Adventures on the Dark Side of Medicine (2010).

IV. Social Determinants of Mental Health

  • Richard Wilkinson & Kate Pickett, The Spirit Level: Why More Equal Societies Almost Always Do Better (2009).
  • Michael Marmot, The Health Gap: The Challenge of an Unequal World (2015).
  • Bruce Alexander, The Globalisation of Addiction (2008).
  • Johan Galtung, Violence, Peace, and Peace Research (1969).
  • WHO, Social Determinants of Mental Health (2014).
  • CDC, Youth Risk Behaviour Surveillance System (various years, esp. 2021).

V. Gig Economy, Neoliberalism, and Social Breakdown

  • Guy Standing, The Precariat: The New Dangerous Class (2011).
  • Arne L. Kalleberg, Precarious Lives: Job Insecurity and Well‑Being in Rich Democracies (2018).
  • Philip Alston, UN Special Rapporteur on Extreme Poverty (2017–2020).
  • OECD, How’s Life? Measuring Well‑Being (annual).
  • IMF & ILO reports on labour precarity (various years).

VI. WSWS and ICFI Analyses (Primary Marxist Sources)

(These are not reproduced; only titles and dates are listed.)

  • “Mental Illness and the American Dream,” WSWS, two‑part series (1999).
  • “Youth Suicide and the Social Crisis,” WSWS (various analyses, 2015–2024).
  • “The Gig Economy and the Assault on the Working Class,” WSWS (2017).
  • “The Social Crisis in the United States,” WSWS (multiple reports, 2008–2024).
  • “The Breakdown of Public Health under Capitalism,” WSWS (2020–2023).
  • “The Anglosphere Crisis: A Social Catastrophe,” WSWS (2023–2024).
  • ICFI Statements on Social Conditions and Mental Health (1999–2024).

VII. Additional Critical Works on Capitalism and Social Suffering

  • Mark Fisher, Capitalist Realism: Is There No Alternative? (2009).
  • Jonathan Crary, 24/7: Late Capitalism and the Ends of Sleep (2013).
  • Byung‑Chul Han, The Burnout Society (2010).
  • Richard Sennett, The Corrosion of Character (1998).
  • Zygmunt Bauman, Liquid Modernity (2000).
  • Franco “Bifo” Berardi, The Soul at Work (2009); Heroes: Mass Murder and Suicide (2015).
  • Silvia Federici, Caliban and the Witch (2004) — for the historical roots of social discipline.
  • Cedric Robinson, Black Marxism (1983) — for racialised dimensions of social control.

VIII. Archival and Government Sources

  • UK Parliamentary Papers on Lunacy Acts (1845–1890).
  • US Surgeon General, Mental Health: A Report of the Surgeon General (1999).
  • WHO Mental Health Atlas (various years).
  • UN Human Development Reports (annual).
  • Office for National Statistics (ONS), UK — mental health, labour precarity, youth well‑being datasets.
  • US Bureau of Labour Statistics — gig economy and contingent work surveys.

IX. Suggested Further Reading for a Marxist History of Psychiatry

  • R.D. Laing, The Divided Self (1960).
  • Franco Basaglia, Psychiatry Inside Out (1980).
  • Thomas Lemke, Biopolitics: An Advanced Introduction (2011).
  • Mark Rapley, The Social Construction of Mental Illness (2004).
  • Richard Bentall, Doctoring the Mind (2009).
  • Nikolas Rose & Joelle Abi‑Rached, Neuro: The New Brain Sciences and the Management of the Mind (2013).