On 20 October 2020, nothing changed in the increasingly excitable world of mental health.
A lot could have changed. We could have ended the day on a high, having secured a strong statement of intent from one of the world’s most powerful corporate figures and mental health evangelists. It could have helped rescue the mental health movement from the sins of the past and coaxed it in the right direction.
Instead, we had another leader with millions of followers demonstrating exactly why the mental health conversation remains badly broken despite all the hype around the subject.
What Kiran Mazumdar-Shaw (executive chairperson of the multibillion-dollar biotechnology firm Biocon; trustee of the Live, Love, Laugh Foundation started by Bollywood superstar Deepika Padukone; and a regular presence on various "powerful people" lists) chose to emphasise in a column published on 20 October was a symptom that we’ve learned nothing from the disastrous mistakes that turned the world into a cesspool of distress in the first place.
The column, ‘We must step up philanthropy for mental health’, was well-intentioned. It contained all the important facts routinely highlighted by the mental health sector: the mounting incidence of mental health problems, woeful access to care, pathetic government budgets, the need for philanthropists to adopt it as a cause as vital as education or clean water.
But none of that mattered in the face of a single fatal flaw: the author’s rationale citing the World Health Organization that we must invest in mental health because well, if we don’t, it will cost us "over a trillion dollars in lost productivity".
This is what that sounded like to me: care about mental health — but not because it is a fundamental human right. Care about it because it is a goose that lays golden eggs. Apparently, a mentally healthy society is not the civilisational goal it ought to be. It is just another commodity, another dumb variable on an Excel sheet. Manipulate well for best returns.
No other argument makes advocates and activists striving to change the way society talks about mental health feel more like monkeys on an oily pole.
The absurd logic of productivity
I’m tired. We shouldn’t have to talk about this in 2020, not barely a couple of weeks after a gung-ho World Mental Health Day (10 October) filled with urgent-sounding webinars and social media campaigns about how we will create a fairer and more just world order after this pandemic. A world built to protect the most vulnerable among us, because if the pandemic has hammered home one truth, it is that none of us is safe till all of us are.
And yet, here we are. Still selling mental health as a worthy "investment" because it promises bumper "returns". Still salivating over productivity – never mind all the evidence that this productivity obsession is exactly what has brought us to our haunches.
Last year, the International Labour Organization declared that "stress, excessively long working hours and disease contribute to the deaths of nearly 2.8 million workers every year". All the road accidents in the world kill fewer than half of that number. Not to mention the additional 374 million people who "get injured or fall ill because of their jobs".
But this devastation has not put an end to the absurd logic of the Productivity School of Mental Health:
- We become sick because our culture is obsessed with productivity.
- So, we must do something about it.
- Because if we don’t, productivity will suffer.
In this schema, an individual’s mental health is of no consequence as long as they can maintain their productivity (or the appearance of it). This is dangerous for everyone, but particularly for those who have been systemically robbed of the power and agency to be their most "productive" selves – almost everyone who isn’t a cishet upper-class, upper-caste man.
Cultural theorist Mark Fisher drew attention to people who have been told all their lives that they are "good for nothing". "For those who from birth are taught to think of themselves as lesser, the acquisition of qualifications or wealth will seldom be sufficient to erase – either in their own minds or in the minds of others – the primordial sense of worthlessness that marks them so early in life."
Then there are those who can’t be pigeonholed into the "mentally ill = unproductive" stereotype. Take me as an example. I am a high-functioning depressive and have several friends who also live with that identity. But just because people like us can pack in 16-hour days doesn’t make it okay. Neither should our ability to be productive disqualify us from the right to care and compassion.
"Acceptable: productive paranoia, actionable anxiety and monetisable mania," someone said in response to a tweet where I explained my concerns with Mazumdar-Shaw’s column. "Unacceptable: paranoia, anxiety, mania."
No, touting productivity as the motivation to invest in wellbeing doesn’t work
How do we not realise how warped all of this is? How is it that even in this train wreck of a year, which has stripped bare the limits of human ambition and dismantled business as usual, we cannot get rid of the itch to justify everything that is right in the name of cold economic incentives?
The answer is simple: a poverty of imagination. We don’t believe prioritising mental health is worthy enough by itself unless we hedge the demand with a quantifiable quid pro quo. As someone said on LinkedIn:
"Tanmoy I agree with your sentiment, I think Ms Shaw is putting across the point in the only way most corporates understand any problem [,] in terms of ROI (return on investment)/dollar value."
I would be inclined to engage with this argument if, as I have hopefully established by now, the pursuit of ROI weren’t the very Mammon we need to dethrone.
But leave that objection aside for a moment. Touting productivity to promote wellbeing isn’t even a particularly clever – or new – tactic. Not only is this tactic not working, it is taking us backwards.
The modern workplace and its myriad "employee engagement" and "employee happiness" programmes are a prime example. Workplace wellness drives have their origin in decades-old employee assistance programmes (EAPs), and they’ve become a staple of the business world where corporations are fighting a war for talent via free smoothies and "bring your pets to work" days.
Here’s a piece of historical trivia: EAPs were originally meant to tackle, among other things, alcoholism among employees, and, according to one definition, their purpose was to address employees’ "productivity" and personal issues that may affect their "job performance".
That legacy continues. Most employers only care about their employees when doing so directly or indirectly translates into more dollars. The internet is brimming with gung-ho projections of improved productivity – 20%! 30! 50%! – if only employers were to invest in the latest HR trick.
Extractive capitalism has trained us to believe that there’s nothing wrong with this line of thinking. After all, businesses "do well by doing good" all the time. Except touting business outcomes for doing the right thing is the enemy of wide and sustained change. It might be effective when the objective is to improve something narrow and specific relatively quickly – say, addiction levels in employees. But if we want to commit to a vast, nebulous goal, such as building a mental health-friendly world sans hypocrisy, we must start throwing our weight behind real, sweeping cultural change.
Heck, yoking wellness to productivity doesn’t even make good business sense. While companies burn through many millions of dollars in the pursuit of happier employees, the returns remain abysmal. In the US, for instance, just over 30% of employees in a Gallup survey were found to be engaged at work. Worldwide, the percentage was less than half of that.
A meaningful shift must begin with one declaration: mental health is an inalienable human right, not a handout. Without it, there is no freedom or dignity. As the American Psychological Association explains, adopting a rights-based approach to mental health is critical for "clinical and economic reasons, as well as moral and legal obligations".
At the workplace, this means abandoning hollow perks in the service of "happiness" and adopting structures that guarantee "humanity" instead – raising minimum wages, throwing out the language of violence and war from business ("killing competition", "headhunting"), incentivising empathy, celebrating humane metrics – for instance, how many of your employees can afford having babies? – rather than merely financial ones.
These aren’t pie-in-the-sky targets; it is possible to build perfectly solid businesses while opting out of the brutal excesses of capitalist competition. Dan Price, CEO of the US American payments processing firm Gravity, was ridiculed as a "communist" for raising everyone’s wages to a minimum of $70,000 five years ago, but his company is now doing better than ever. As is the project-management services company Basecamp, which trashed every conventional measure of business success and productivity and yet managed to deliver great results.
The only thing Gravity and Basecamp might have had to sacrifice is the desire to spawn the kind of massive, lusting-for-growth, world-conquering enterprises that Silicon Valley has a reputation for spitting out, along with all the moral, ethical and legal transgressions – and all the burnt out employees – that are an almost inevitable fallout of such lust.
On a macro level, the productivity carrot hasn’t lured those who control the purse strings of the global economy. "Regrettably, despite commitment from world leaders to include mental health care in universal health coverage as part of the Sustainable Development Goals in 2015, this pledge was not translated into reality," an editorial in the Lancet reminds us.
According to the WHO, which chose "Move for mental health: let’s invest" as the theme of this year’s World Mental Health Day, countries spend on average only 2% of their health budgets on mental health. "Despite some increases in recent years, international development assistance for mental health has never exceeded 1% of all development assistance for health. This is despite the fact that for every $1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of $5 in improved health and productivity."
The Lancet explains that the harshest fallout of this apathy is felt by those trapped in the vicious cycle of economic hardship and poor mental health, "where poverty is both a contributing factor to mental health problems and a barrier to accessing services that might help."
We can’t fix this by sticking to the old rulebook. The state has an obligation not just to invest in but nurture the mental health of every citizen – including those who may not meet its productivity benchmark. That is the essence of rights-based thinking.
What do we do with the ‘unproductive’ among us?
With the world economy in tatters, capital P Productivity will be right at the top of every desperate decision maker’s agenda in the post-Covid-19 world. Anything that is seen as even a slight aid to productivity will be co-opted and gobbled up.
This will in turn fan more disingenuous arguments marrying wellbeing to productivity. Mazumdar-Shaw said during our Twitter exchange: "Economic employment is a basic human need. If you cannot get a job because of mental illness is it fair? Don’t trivialise the economic impact on human lives."
Nobody is denying that we need to create jobs. But how accurate is this stubborn belief that more productivity and more growth is what will keep us afloat?
"Economists have long assumed that we need growth to improve people’s lives," economic anthropologist Jason Hickel wrote elsewhere on this website. "But it turns out there’s no empirical evidence for this argument. Beyond a certain point, which high-income countries have long since surpassed, the relationship between GDP and human wellbeing completely breaks down."
Going back to Mazumdar-Shaw’s tweet, we need to place humans above the economy, precisely because we know how deadly the "impact on human lives" is when we become slaves at the altar of productivity. And we don’t just need jobs for people with mental illness – we need jobs that don’t make people ill in the first place.
We cannot promote mental health only because it is fodder for economic growth. That’s like promoting living because zombies aren’t known to be great office workers.
Language matters. Especially when it comes from the powerful.
The Lancet has some critical advice: "The economic argument for investment in mental health services is clear and has been made many times, but there is also an ethical imperative for investment, both to redress historic wrongs done to vulnerable communities and to right current inequities ... Investment must be about more than just money if mental health services are to be made fit to address the challenges of the COVID-19 and post-COVID-19 era and to become resilient against future public health crises."
While imagining the future, we must keep at the centre those whom we habitually push to the margins – everyone we dismiss as "unproductive".
"Mental health is not job-related, for crying out loud," Indian journalist Uma Asher explained on Twitter. "Unemployed people, minors and retirees are also entitled to it. Sad that it needs to be said."