From a Marxist perspective, the low pay rates of jobs with low psycho-social quality is related to the concept of exploitation – the necessity for wages to be worth less than the value created by the worker’s labour, in order to continue to make a profit. A further component of employment’s potential detriment to mental health, well-being and recovery which is not covered in the research carried out by Butterworth and other (see part 3), is workers’ experiences of alienation. In his book which looks at work and sickness, Paul Bellaby discusses the way in which jobs can accentuate certain qualities of the body and mind, but can also depreciate others. A participant from one of the qualitative interviews quoted in this book talks about alienation with great clarity, as well as its impact on well-being as a worker undertaking solitary tasks.
You hardly talk to anyone. You have no idea what is happening around you – and you lose touch with what is happening in the world. After a while it gets so that you have no conversation, and when you go out socially you do not know what to say – eventually you lose all your self-confidence. (Bellaby)
She also described feelings of exploitation adding that “at the factory, they didn’t seem to care about any of this – all they wanted out of you was ‘more, more, more!’” (Bellaby). The apparent contradiction of work being simultaneously a potential means of improving and eroding mental health as understood through a recovery and well-being framework, suggests the need for a dialectical analysis of this relationship. Hegelian dialectic theory holds that contradictions are inherent in philosophical considerations, and that any intellectual proposition or thesis, can be opposed by an antithesis the combination of which results in synthesis as their mutual truths are reconciled. Marxian dialectics is similar in that “it includes in its comprehension an affirmative recognition of the existing state of things, at the same time, also, the recognition of the negation of that state, of its inevitable breaking up” (Marx,1873). Marx, however, conceived this primarily in relation to the economic order of any period which, as moving towards a state of maximum efficiency will develop weaknesses or contradictions within it that bring about its decay.
In response to the Hegelian dialectic issue of work and health being at time synonymous, and on other occasions mutually exclusive, policy has looked to resolve the internal conflict through moderate reforms. An example of this from Brittan, is the Independent Inquiry into Inequalities in Health Report published 1998 which recommends policies which “improve the opportunities for work and which ameliorate the health consequences of unemployment…[and] improve the quality of jobs and reduce psycho-social work hazards” (Acheson, 2000). In New Zealand similar goals have been asserted by the consumer movement in the publication Our Lives in 2014: A Recovery Vision from People with Experience of Mental Illness (Mental Health Commission, 2004). While not advocating for specific policy in this particular document, the goals of the authors and the wider mental health community expressed call for equal opportunity to work on the open labour market with the support needed to work successfully, increasing average income and less reliance on income support.
In the application of Marxian dialectics to mental health, the mental health employment situation is merely indicative of a larger contradiction inherent in every economic system to date, that as it works towards maximum efficiency, it begins to create social issues within itself that will cause it to fall apart and be replaced. Regarding mental health and illness, decreasing well-being for the mental health consumer population (and wider society as well) comes as a result of employment, as employment is structured under the current economic system. Some of the examples of the positive impact of occupation mentioned in earlier parts of this series highlight this. As an example, for the GROW participants interviewed in the research by Kelly and others, reciprocity, social connectedness and achievement associated were with employment, however their occupation was in unpaid peer support outside of the competitive labour market.
The decreased mental well-being that mental health consumers experience in their occupations is largely in the low psycho-social quality, low paid jobs in which they disproportionately work. As the Mental Health Foundation notes, unpaid work, while linked with improved mental health, has limitiations as it will not allow people to provide for themselves, and gains in well-being are less than those experienced by people working in decent paid positions, “while voluntary work was recognised as an option, paid work was seen to have increased benefits, such as people “being part of mainstream society” (Peterson for the Mental Health Foundation, cited in Banks 2011). A question we can be asking ourselves is: how can we maximise the positive experiences of employment or occupation for mental health consumers while eliminating the negative impacts of unequal power relations?
In reality, this is a question that the mental health community has already been addressing, and with positive outcomes. The establishment of Mad Markets in the United States and utilisation of time bank and local exchange trading schemes by mental health consumers has allowed for the dual benefit of experiencing positive aspects of occupation outlined in the first part of this series, whilst avoiding the detrimental impacts of exploitation and alienation characteristic of capitalist labour markets. These forms of alternative market engagement are somewhat problematic in that they do not address initial wealth inequalities and the financial capital available to different sectors of, or individuals in society. It is also difficult to imagine a situation where all mental health consumers or people negatively effected by their working conditions can opt out of paid employment in favour of providing products or services as an individual in an exchange market.
What remains for the mental health community to work towards is a greater task than bringing these alternatives out of the margins. Bringing about radical change to the way we do work as a society supports recovery for the mental health consumer and benefits the well-being of society on the whole.