We all know well the toll that capitalism takes on our lives, and the physical and mental strain that exploitation and oppression involves. Distress intensifies in times of austerity, with isolation of people from each other giving new actual and virtual twists on alienation at work, and for those excluded from the workplace. Capitalism is bad for your mental health.

Free associations

Whether or not everything would be hunky-dory when we have overthrown capitalism is a moot point, and anyway we cannot wait, so what should communists involved in the field of mental health do now, and how should they think about their role and aims? One answer has just been given by Dorotea Pospihalj of the Red Clinic, an avowedly internationalist collective of therapists committed to providing accessible treatment who define themselves as communist.

This recent thought-through answer in the online paper For a Communist Clinic is conceptualised using specific theoretical resources; it is psychoanalytic, which not all radical mental health practice is nor should be, and Dorotea’s paper is aligned with the work of the old Maoist philosopher Alain Badiou. For Badiou, the ‘communist hypothesis’ is about an always open possibility that we enact through a range of events that will include the domains of politics, of course, and science, art and love, the last of which frames much clinical work whether it is psychoanalytic or not.

This does not mean that communists in the clinic attempt to indoctrinate, nor even subtly suggest that their patients become communists, but there are aspects of the ‘free association’ that is possible in the clinic that chimes with the kind of ‘free association’ that we struggle for in the field of political economy. As Dorotea Pospihalj points out, there are psychoanalysts of the right as well as of the left, and she draws on her own experiences of political activism in Slovenia – she is based in Ljubljana – to show how some bizarre political choices can be made by therapists who think they are ‘radical’.

There is a sometimes jokey recent webcast with Dorotea, who stood as a candidate for the ecosocialist Left party in recent elections in Slovenia, available on the Psy-Fi Psychology and Theory show, and another Psy-Fi episode is about similar initiatives in Brazil with Christian Dunker and myself; we can see here how important an internationalist perspective and organisation is to the Red Clinic, and to anything that pretends to be ‘communist’ in clinical work. We not only learn from each other’s quite different experiences as we talk and act in solidarity with each other, but we are able to break out of the national peculiarities and limits of our own national traditions. We need to break out of those limits in our therapeutic work and in our conceptualisation of what it is we are doing.

The politics of truth

What underscores communism in the clinic in conditions of capitalism – and who can say whether this kind of clinic will actually be necessary under communism – is a politics of truth combined with theoretical reflection. This argument, again drawing on the work of Alain Badiou, is something that is actually familiar to revolutionaries outside the clinic; we bring our analytic understanding of the nature of capitalism to bear on our politics and we know that we must speak the truth to power. We are beset by lies in this society, and our political activity is grounded in truth; speaking truth to others and speaking truth to ourselves about what we are doing.

The Red Clinic is one of the sites for taking this work forward, but not the only site. Meetings about the Red Clinic have grappled with the role of particular models of therapy and our relation with treatment that is already available on the National Health Service. The NHS is a valuable resource, and anticipates in its form – free medical support at point of treatment for all – what we would hope for under communism. It is not for nothing that rabid right-wingers hate the NHS and want to privatise it, destroy it.

While we fight to defend the NHS we also mobilise to extend what is good about those services, increase participation of service users and make the treatment something that is empowering rather than demobilising, something that embeds support in social networks instead of increasing the isolation of people who are simply doled out antidepressants because that is cheaper and quicker. Here we need to link with other radical initiatives like the Free Psychotherapy Network and the recently formed campaign for universal access to counselling and psychotherapy.

Local and global

These initiatives need to be local as well as international. In Manchester, for example, the CHARM network that was set up to challenge attempts to concentrate mental health care in a large hospital in north Manchester has also been extending its links with activists and users of services to address questions of racism. The Red Clinic has been devoting energies to the struggle against racism and apartheid, with its practitioners supporting a group of clinicians in Palestine, and hosted an online discussion of work on ‘Mental Health in Palestine: Resisting Settler Colonial Partition’.

Communism is an opening to another world beyond capitalism, something that needs to be built now, and we know well from radical mental health initiatives around the world, whether that is in England and Wales or work in indigenous communities in Amazonia, that working class self-activity needs to be intimately linked with struggles against racism and sexism and other forms of oppression. The work in Brazil reflects on the process of listening as the core of progressive work, not immediately obviously communist, nor necessarily psychoanalytic, but congruent with what it is to be a communist in political activity.

For a communist clinic

There is a long history of radical therapy that has known, in its heart, that the capitalist system must be overthrown before the crisis in mental health services can really be resolved. The reflections on communism in the clinic pick up the threads of those debates. Meantime, we need to defend what services we have and build better ones, the kind of services that are democratic and open, and that facilitate the kind of free association that enables people to fight for communism.

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