Psychiatry and communism, and Stalinist false friends

Ian Parker argues that we need to take a radical step away from the medical model in mental health.


No one can promise that everyone will be happy under communism. There will be distress. We are human beings living in bodies that break down and die, and we are social beings, so conflicts with others sometimes cut deep. And we will inherit a planet in very bad shape from the ravages of capitalism.

Care and pain

What we will have is a stronger network of supportive creative relationships. That’s basically what communism is; a world in which we collectively manage our lives for our good and not for profit. Care will replace greed. This is what Marxism aimed at before it was turned into a kind of religious faith of the bureaucracy in the Soviet Union, and then other places that took that as a model of how to run things. This is ‘open communism’, something very different from the Stalinist police states that closed things down. To get there means opening it now, and opposing those who close things down around the current ideology.

Key to that current ideology that serves capitalism and justifies it is medical psychiatry. The medical model in psychiatry pulls the shutters down on possibilities of change. The psychiatrists often hand out life sentences with their diagnoses that tell us that it is our brain chemistry that is wrong, low serotonin was a favourite theory until recently, maybe genetic or maybe just hard-wired, and that we can never change that. We are told we should be ‘realistic’ and give up on changing things; their capitalist realism holds us down and sends us down into pessimism and worse. This is the road to more pain now and no hope for things getting better.

Locking our lives into our biology, into brains and genetics, is an expression of capitalism; the powerful triumph, enrich themselves and hand down their wealth, and we are told this is human nature. But we are also locked in place by the ideology of the police state bureaucracies that told us that they were socialist or communist. They were not. Their ideology mimics and replicates capitalism, and there we find a mirror-image of capitalism realism; that is, ‘stalinist realism’ that blocks the way to open communism.


A trap for us who really want to change the world and open the way to changing ourselves lies in medical psychiatry. It is there among the mainstream psychiatrists who effectively now serve the multi-million pharmaceutical industry, sometimes reluctantly because they cannot think of an alternative, and it is there among some of the critics who think they are rebelling against psychiatry but are actually reproducing it.

There are two jaws in this trap. There are those who make it seem like there is a shortcut to happiness, and they attack psychiatry with their own agenda. They are right to reject psychiatry, but they so often speak from the right. The discovery that there is no clear link between depression and chemical imbalance – the ‘serotonin theory’ of depression – is a case in point.

This news was recently seized upon by The Light which publishes stories about climate change as fiction alongside transphobic articles and religious stuff. Their article about the power of ‘Big Pharma’ was in the same issue as anti-vaccination scare stories. This is also the world of Scientologist-style ‘anti-psychiatry’ and their version of ‘human rights’. They won’t allow people to take control of their own lives, whatever they say about being free or ‘clear’, and they are virulently hostile to communism of any kind, only interested in peddling the caricatures of it that apply to the Stalinist states. In place of communism, they turn to conspiracy theories of different kinds, and that always ends badly.

The other jaw of the trap are those who pretend there was nothing much wrong with Stalinism, covering over the awful use of psychiatry in those fake-socialist states, and its use as a tool of social control. Not only are they wrong on that account, and do no real favours to those who are working towards open communism, but they also too often embrace the language of psychiatry, even when they pretend to be opposing it.

These are the ‘realists’ who buy the psychiatric story that you can read off what happens in our minds from what is happening in the brain. Then they buy into the ways that psychiatry cuts up the world, accepting diagnostic categories and trying to use them as an ‘empirical’ or ‘scientific’ way of explaining distress. This is the stalinist realist mirror-world that criticises mainstream psychiatry but actually keeps that ideological machine going. It includes writers who say they are Marxists – and should be taking us toward communism – but who are making some really bad ideological moves.


This is where you will find them taking for granted that, for example, depression affects 4.8 per cent of the population. This is stalinist realism, so let’s just unravel that claim quickly. The assumption is that there is this thing called ‘depression’, and, when pressed, supporters of the medical model would say ‘clinical depression’, which simply makes it seem something more concrete. What we experience in our millions is replaced with a medical name, ‘depression’, and a clinical diagnosis and a percentage.

Then, once you are in this ‘realist’ trap – the ideological claim that tells you this 4.8 per cent is the brute reality that has been really accurately measured by the psychiatrists and statisticians that take the categories for granted – you are on the way to grasping for some good news. You will then find critical researchers who say they are Marxists, writing fairly fine stuff against the serotonin theory of depression, but then, from within the stalinist realist mirror world, claiming that ‘depression in Cuba affects only 3.8 per cent of the population’.

Yes, we should lift the blockade and recognise that health of all kinds is under pressure there, but this 3.8 per cent claim is a weird way of making it seem like Cuba is socialist, and, the part of the package we need to notice here, making it seem like there is a way of turning psychiatry from being riddled with ‘biochemical determinism’ into being, wait for it, ‘dialectical materialist’. No surprise, then, that the same author is keen to explain to us that ‘markets’ in China are very different from ‘markets’ under capitalism, because, and this is a head-scratching Stalinist assumption he makes, China is ‘socialist’.

This makes clear the logic of the argument, and it is no accident that there is a link between this reframing of markets and reframing of psychiatry. This is Stalinism that covers up criticism of Cuba and China on the basis that they are socialist, and stalinist realism that pretends that we can take psychiatric research and the categories it uses on good coin. We cannot and should not.


The last thing we need is more of the message that tells us what we cannot do, what our limits are, and, worse, that there are psychiatrists, whether capitalist or Marxist, who can find out. That way pretends to fix things but actually fixes us in place. It is capitalist realism in psychiatry that is then replicated by some of its critics as stalinist realism.

If we really want an alternative, we need an approach to mental health that is focused on our potential for change, the way that we transform ourselves in the course of changing society, and the way that different societies have quite radically different ways of understanding what is normal and what unhappiness is. That kind of critique refuses psychiatry and can also open communism, our sense of ourselves and our creative energy as a collective anti-capitalist force.

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Ian Parker is a Manchester-based psychoanalyst and a member of Anti*Capitalist Resistance.

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