The Surveillance State of Mental Health


A few centuries ago, society’s mentally unwell folks were free to exist in their communities without much backlash. In fact, they held a laudable position within society, since their unreason was read as a valuable foil to mankind’s stiff adoration of reason; the mentally ill undermined the stuffy, serious air that enveloped human affairs (Madness and Civilization, 27). From our contemporary position in which the mentally ill are villainized, associated with crime, and assaulted by lawmakers and the biomedical community, it is strange to imagine that the mentally ill were a hearty source of entertainment because they made human seriousness a laughing matter. 

The total inversion — from acceptance to pathology— invites us to question our society’s stance towards psychological well-being. It is not simply that the advances of life sciences, particularly in neurochemistry and biomedicine, have given us a more truthful sense of mental illness. In other words, telling the story of social mores around mental illness requires a much richer history than simply procuring the historiography of a society that once treated depression with baths transforming into a society that treats depression with SSRIs. A paradigm shift occurred in which mental illness no longer provided a powerful counterpoint to human arrogance; it became a threat to society, which produced the imprisonment of the ‘insane’ in mental asylums. 

But it is already cliche that psychiatry has profoundly conservative roots. Psychiatrists and psychologists have worked alongside social elites, as they did when they determined that mental illness, not a yearning for freedom, caused slaves to escape or revolt; the mental health care industry generates 50 billion dollars of profit each year, allowing it to yield substantial power over society and its discourse, even as it addicts patients and inflicts harm; the industry rewrites social phenomenon as biochemical phenomenon. Fundamentally, these all point towards the industry’s great success, which is also the praxis of its evil: it teaches people to be consumers of the mental health care industry, thereby reducing their self-efficacy and teaching them to live within an open-air panopticon in which we internalize the values of the status quo. This all occurs despite the documented fact that psychiatrists cannot even successfully differentiate between the ‘mentally ill’ and the ‘sane.’ 

Madness, Imprisonment, and Surveillance

Foucault’s Madness and Civilization is instrumental for understanding the social status of madness in the two most recent centuries. The West shifted from acceptance of folly to stigmatization and imprisonment of those same populations. This proves that the meaning of mental illness has changed profoundly, calling specialists to treat those people in profoundly punitive ways. Foucault shows that modern society suddenly decided that the Mad were irreducible and unassimilable into modern culture, which logically led to the mental asylum. Mental illness was an outlier to human reason and therefore needed to be quarantined.  

In fact, the 18th and 19th century reformists believed that it was cruel to lock-up the Mad alongside prisoners not because the mad needed better care, but because society at-large believed, “prisoners deserved a better fate than one that lumped them with the insane” (Madness and Civilization, 223). The modern era, therefore, begins with the sense that mentally ill people should occupy a lower social status than criminals. Criminals simply transgressed from the law; mentally ill folks, on the other hand, transgressed from human reason and therefore human nature. The modern mental asylum has its historical roots in the imprisonment of the Mad, who were viewed as animals. 

Another one of Foucault’s great works, Discipline and Punish: The Birth of the Prison, can help us appreciate what the imprisonment of the mentally ill actually means. Understanding the birth of the asylum and its procedures requires that we understand the social body surrounding the institution. After all, the birth of the asylum occurs nearly simultaneously with the birth of the prison— and both institutions reflect a shift away from carceral punishment, public hangings, and otherwise public humiliations of people who transgressed from the king’s power. While the Classic images of punishment revolved around punishing the body in public in order to affirm the King’s Absolute Power, the modern era shifts to covert, isolated, and hidden ways to discipline citizenry. 

The visibility of the king’s power undermined its presence, since people could clearly see it and subsequently resist against it. It is much harder to resist something that is hardly visible in daily life. And yet, despite the covert discipline that prisons and police represent, subtle power is much more intimate. In the modern era, a new power emerged in which, “the mind [is] a surface for the inscription of power,” (Discipline and Punish, 102). The strict regulation of routines, eating times, shower times, imposition of work, and so forth in prisons reflects the need to regulate every part of a person’s life in order to change their soul. We witness the same phenomenon with schools and their routinization of daily life; we even see it in the fact that areas of study are still called ‘disciplines,’ since each academic ‘discipline’ implies a compulsion to behave in a particular way.

Even the architecture of prisons reflected this all-encompassing power. The hallmark being Jeremy Bentham’s panopticon— a spherical environment in which a tall watchtower stood at the center, whereby prisoners could be constantly monitored in their cells, but the prisoners could not tell if someone were in the watchtower — meant that they had to internalize the rules. They were always possibly being watched. The same goes for other social mechanisms of control. Foucault asks, “Is it surprising that prisons resemble factories, schools, barracks, [and] hospitals, which all resemble prisons?” (Discipline and Punish, 228). Many of these places, especially schools and hospitals, stand as symbols of social good and progress, yet they implement the same techniques of discipline as prisons do. 

We should ask ourselves if our ‘de-stigmatization’ of mental illness, of our constant supervision of our emotional well-being, of our willingness to ‘seek help,’ is not an open-air panopticon in which we internalize the values of the status quo and invite society’s powerful groups into our bodies, minds, and souls. 

The Surveillance State of Mental Health 

The appearance of our mental health apparatus, at a glance, is much friendlier than it was in Ken Kesey’s time. It appears less oppressive and more friendly, which, from a Foucauldian perspective, invites skepticism. 

The soft, pink, and accepting appearance of Mental Health Instagram, for example, hardly seems like a problem. Its widespread use for people to connect and share ideas about mental health is widely recognized, earning it articles in large, mainstream media. Over 12.7 million posts have used the hashtag #mentalhealth on Instagram. This produces an immense amount of data regarding the deepest, smallest, most intimate pores of our lives— our emotions— and perfectly sets us up to be marketed to. In the same way that our phones listen to us talk about cars or cameras, or whatever, and then generates corresponding ads, it also notices our affinity with mental healthcare. Of course, this generates ads that include invitations to see a psychiatrist (I’ve received such an ad just for watching too much Nouvelle Vague cinema, lol). In other words, what is heralded as one of the freest, most individualized experiences enabled by the 21st century, that of social media, which is a source of freedom, curiosity, and communication, perfectly sets us up to be consumers of mental health care. 

While we should not stigmatize certain mental health positions, we should also pause at this movement. On one hand, it provides an opportunity to discuss real issues; emotional well-being is intimately tied, if not synonymous, with existential success. But the stigmatization we experience is seized by powerful corporations. The National Alliance on Mental Illness, a powerful organization and authoritative figure within the discourse, says that we need to destigmatize mental illness. But we should also remember that this organization receives roughly 75% of its funding from the pharmaceutical industry that benefits from the prescription of psychiatric medication. It is as if we are ushered from the confused silence of our bed to the checkout line at the pharmacy. 

Perhaps the first Instagram ad will not lure us into buying into the industry. But the collective effect of social media, of de-stigmatization campaigns we see on buses, at bus stops, on television, etc., via celebrities, and so on causes us to constantly monitor our well-being. We imagine that these people are watching us, monitoring us for signs of mental illness. Given the ever-increasing possible diagnoses, which have tripled in the last 70 years, it is always possible that we have some mysterious problem that will soon need intervention. Francis Fukayama, along with authors like Aldous Huxley, see our path leading towards a world in which simple unhappiness is pathologized. Their dystopian visions were perhaps too naive, since they did not imagine that even children with high-energy levels would be pathologized. 

All of this leads us, like the prison in the panopticon, to worry that we’re not doing well enough— emotionally speaking. That we could be happier. Even the idea that we are supposed to perpetually improve ourselves is toxic. All of these ideals strip our self-efficacy and force us into the manipulative shelter of powerful psychiatric hospitals, pharmaceutical companies, and doctors. We need to think of ourselves less as consumers of mental health care and more as individuals in need of loving, sustaining bonds and meaningful action.