The Enclosure of the Mental Commons: Why Mental Health Has Gotten So Bad and How We Can Respond
D. Brendan Johnson, MD, MTS, Brigham & Women's Hospital / Harvard Medical School, Boston, MA
By almost every measure, mental health is worsening around the world; the 2021 Mental State of the World report found an “alarming plummet in mental wellbeing … prevalent across every single country population that we sampled.” However, besides efforts like the field of Public Mental Health, there have not been convincing analyses of the root and intervenable causes of this rising tide of distress; even former National Institutes of Mental Health director Tom Insel’s 2022 book Healing describes the underwhelming real-world results of the brain-science approach to mental health. Drawing from the alternative tradition of the ‘commons,’ psychiatry may be able to open up a new understanding of what has gone wrong and pursue possibilities of how to make things right. The commons are communally-driven non-state and non-market arenas which produce necessary goods for those involved. The prototypical example is that of English village land use, where commons were a large central agricultural area where otherwise poor farmers (commoners) could collaborate on herding and food production, but which were technically not owned by any person or entity in particular. The commons as concept has extended beyond land; Wikipedia and the Creative Commons copyright license are both vibrant examples of the commons in an online space. It appears that through our language, emotions, spirituality, attention, sociability, fears, memory, tradition, and so on, there is a ‘mental commons’ to which all contribute and which also in turn helps to produce our subjectivities and mental life. The benefit of describing our mental life as part of the mental commons is that the breakdown of the commons is well described; commons are turned from community-provision to private-profit by the theft of fencing-off the commons in a process called ‘enclosure.’ Religious and popular voices deeply protested this at the time; for example the 1647 Westminster Longer Catechism names the sin of “removing landmarks” under the heading of the sin of theft, and religiously-inspired leaders like Gerrard Winstanley led movements to re-occupy the commons. Just as the enclosure of English commons was profitable for large-scale agriculture and moved the poor into cities to work for factories, the enclosure of the mental commons has been immensely profitable for advertisers, social media, banking, and so on. Consider all the mental anguish – profitable anguish – that is generated by a system in which healthcare or education are personally debt-financed instead of publicly provided, or the low-grade distress we all put up with by intrusive advertisements on the sides of roads and in public. Worse yet are the theft of languages in colonialism, or the general loss of hope for the future occasioned by our inability to stand up to the profit of energy companies. In so many ways, these enclosures of the mental commons and our concomitant loss of authentic and human-centric social life cause an increase in fragility and a worsening in mental health. There is a small if robust social movement to recover the concept and reality of the commons, which psychiatry and the field of mental health should join. Instead of a disease or even public health description of worsening mental health, the language of the commons allows us tools to analyze our world and its challenges, and even more importantly, the tools with which to imagine and build a better one.