Mark Fisher in his book Capitalist Realism writes:

The current ruling ontology denies any possibility of a social causation of mental illness.

Fisher then goes on to say that the construct of “chemico-biological problems” benefits capitalism; that this requires sociological, political and philosophical analysis to be recognized; and that the task of re-politicizing mental illness is an urgent one.

But how does the current ruling ontology deny any possibility of social causation of mental illness? And, would it be logical to give a philosophical explanation for mental illnesses’ causation (not the philosophical explanation for what may cause the depression, for example, pervasive levels of societal dysfunction; but of the condition itself).

Mark Fisher writes:

depression is constituted by low serotonin levels; what still needs to be explained is why particular individuals have low levels of serotonin.

He means that there should be a philosophical and political explanation for mental illness. But how could that be done?

  • Not "philosophical and political". But philosophy directed politically rather than chemically
    – Rushi
    Commented Apr 14 at 7:40
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    Mental illness is the Opium of the people Commented Apr 14 at 7:59
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    One possibly useful example is the growing idea of neurodiversity, which partly attributes suffering that neurodiverse people experience to a neurotypical bias in mainstream culture. Evidence given for this point of view is that neurodiverse people who may struggle in "normal" social settings may flourish in other environments (e.g. socializing around shared interests, in suitably comfortable settings). Personally, I think causation is multi-factorial. The choice of which factors "should" be addressed can be a socio/political one.
    – Neal Young
    Commented Apr 14 at 18:35
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    The 'Rat Park' experiment en.wikipedia.org/wiki/Rat_Park has shifted the paradigm in understanding addiction & problematic drug use, exactly to social causation. I think Mark Fisher is polemicising against a specific rightwing mindset embodied by Margaret Thatcher's "there is no such thing as society. There are individual men and women and there are families."
    – CriglCragl
    Commented Apr 14 at 18:45
  • I think it is more that the CRO finds that something helps: medication; and that it can be made easily available for a price. A partial solution that you can sell is more implementable than an idea that people will largely ignore. And, people have been self-medicating for depression for a long time. Providing safe medications is not exactly evil.
    – Scott Rowe
    Commented Apr 16 at 10:27

4 Answers 4


Suppose (without loss of too much generality) that I am anxious. There are two conceptualizations I could consider. First, the one given by the "ruling ontology":

I suffer because I am afflicted by an anxiety disorder. I must receive therapy & counseling in order to manage my experience.

In this view, I have an individual problem and need to solve it at the individual level. However, there is a distinct framing which suggests that there could be "social causation" for my anxiety:

I am forced to suffer because I am resident in a society which induces anxiety and have been brought to embrace anxiety as a way of life. We must receive changes in our social contract in order to improve my experience.

When we look at words this way, we can see that "mental illness", "personality disorder", and other common ways of characterizing reactions to our society are stigmatizing assumptions about individual medical issues which are intended to obfuscate any underlying social causes. Where you ask for "mental illness' causation", you've already assumed an individualist framing.

As Fisher points out, capitalism cultivates the former framing for its own benefit. Quoting from Capitalist Realism, after the portion in the question:

Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital's drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs).

This overarching concept builds from the social model of disability and iatrogenesis of mental conditions.

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    The difference between the "medical model of disability" and "social model of disability" also seems relevant here--as I understand it, the latter identifies (both physical and mental) "disabilities" as instances in which society at large is insufficiently accommodating of human diversity, and punishes (with stigma and exclusion) those who it refuses to accommodate. E.g. a person is not "disabled" because they use a wheelchair; they are "disabled" by lack of ramps and elevators, a lack which denies access to full social participation.
    – Tiercelet
    Commented Apr 15 at 15:18
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    The view you describe is ignorant of the fact that mental disorders a) do show changes in brain chemistry, and b) are often caused by individuals in the core family. Putting this on a society scale and blaming the anonymous capital does not explain the change nor help these individuals as it does not fit the genesis of their problems, even if it certainly is true that societal factors help deepen, perpetuate, and stigmatise manifest problems.
    – Philip Klöcking
    Commented Apr 15 at 18:37
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    @PhilipKlöcking: "often" is a weasel word here. Anecdotally, I was involuntarily medicated and isolated from peers by my parents, siblings, school nurse, school administrator, child psychologist, and pharmacist acting in concert. At some point, we have to start seeing this with systems theory and cybernetics rather than sliding into Brave New World or Equilibrium comfort-pills as the only way for individuals to be happy and fulfilled.
    – Corbin
    Commented Apr 15 at 19:04
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    @PhilipKlöcking: Here's a current example. Smartphone usage can become problematic in high doses. Capitalism extracted attention as a precious resource from people, damaging their brain structures and chemistry. An individualist approach ("parents should stop buying phones for their kids") ignores the societal issues ("maybe we shouldn't produce so many cheap phones").
    – Corbin
    Commented Apr 15 at 19:09
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    You could add that one strategy to "individualize" mental health problems is by framing them as physiological-mechanistic disturbances. And (irony) a biological-chemical-mechanical defect cannot have a political reason, right? What is needed is an individual bio-chemo-mechano fix: A pill, an electroshock or a lobotomy. (/irony). That's where Fisher's "why particular individuals have low levels of serotonin" aims at. Fisher certainly contends that the chemistry is just the physiologically measurable symptom/phenomenon of a mental state which is intertwined with the individual's social network. Commented Apr 15 at 22:10

"The current ruling ontology denies any possibility of a social causation of mental illness."

The actual debate is about a politics where problems are essentially systemic vs a politics where all problems reduce to problems of the individual (psychological problems, social problems, political problems, all problems). Indeed, it is a fact that, post WW2, there has been a systematic bias towards the latter, made concrete especially by the directives of the WHO, but by now integral to the "global" message and to the very notion of normality, which boils down to functional normality in the behavioural sense.

Few additional notes for more substance, just consider that it's hard to keep these neutral given the nature of the topic, so please take these with some Socratic attitude: :)

There are of course main themes to political philosophy and to a criticism of Capitalism in particular, and I have tried to hint at how Fisher's considerations can be understood in the context of those.

Indeed, Fisher's "current ruling ontology" and how it "denies any possibility of ..." is an instance of, and another way to say the well known problem of cancellation culture and the very systematic dismantlement of the dictionary that goes with: and with it the dismantlement of all categories of culture, thought and judgment, which is the point. In other words, Newspeak is such that one cannot even think "non-normal" thoughts, even less express them.

That said, that all "problems" are essentially systemic is in fact a result of the Cybernetics school, approx. first half of the 50's (G. Bateson in particular for psychology). But Cybernetics, indeed, has been cancelled, and the politics since then are the exact opposite of all that cybernetics had suggested, i.e. (among other things) all problems reduced to problems of the individual, and, more precisely, to individual pathologies. The idea being: "You have a problem? You are the problem..."

  • Good start, but why should somebody care about this bias and shift in perspectives?
    – Corbin
    Commented Apr 14 at 17:25
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    @Corbin Why should anybody care about the future of life, intelligence, and even decency on this planet? Or simply about the future of our kids in a world that is going full-fledged 1984-nazi? The issue is political in the most concrete sense, and 1) please rather try and ask actual questions if you lack coordinates, for one thing I am way past 1st year composition school; 2) rather you try and explain (not to me) how "iatrogenesis" and that piece of dictionary is cogent, or relevant, or even just on topic. -- I hope that helps, I am not interested in polemics. Commented Apr 15 at 1:19
  • Sorry, you're right. I'll be more direct. I downvoted this answer because it doesn't connect back to capitalism at all. I think it could be expanded into a complete answer, though.
    – Corbin
    Commented Apr 15 at 3:19
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    @Corbin "I downvoted this answer because it doesn't connect back to capitalism at all." Neither does your own answer, and in any case capitalism is mentioned in the Q only in passing so it seems like a weird reason for a downvote
    – Marc
    Commented Apr 15 at 15:26
  • @Marc: I've added a quotation to my answer which matches the quotation in the question and explicitly mentions capitalism. Thanks!
    – Corbin
    Commented Apr 15 at 18:15

Taking alone the three keywords from the heading of your post: Ontology – social causation – mental illness.

  • There are different types of mental illness, see ICD-10.
  • There are diffent social environments.
  • And during the history of philosophy different ontologies have been proposed and investigated.

At least, any hypothesis on this field should clarify:

Which mental disturbance is caused or inforced by which social environment, and to which degree in comparison to other causal factors?

I assume that you mean by “ruling ontology” in your post simply an influential thesis in social science or psychology.

In order to assess Fisher’s thesis it would be helpful if you could provide some of his arguments, which you find convincing. And also some counter-arguments against those which do not seem so.

Otherwise the gap is too wide to link depression with the level of politics or philosophy.

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    This answer exhibits the "ruling ontology".
    – Corbin
    Commented Apr 14 at 17:19
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    @Corbin Please give me a hint why you think so, thanks.
    – Jo Wehler
    Commented Apr 14 at 18:22
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    The answer implies that "mental illness" is extant and classifiable; these are ontological claims which individualize gross harms at the cultural level. It also tries to direct attention away from capitalism and towards academia.
    – Corbin
    Commented Apr 15 at 0:49
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    Well, while "ontology" is somewhat pretentious, Fisher uses it, I think, because he suggests that it is more than just an influential thesis, even more than a paradigm: It is a holistic (all-encompassing, complete) understanding of "how the world is", or at least how the human mind is. Commented Apr 15 at 22:15
  • It always annoys me when someone gives a 'science' answer and other people criticise it by saying, "that's just more science!" They need to replace science with their better method then. (but that would be science, to do something better! darn.)
    – Scott Rowe
    Commented Apr 16 at 10:51

Carefully note that when a mental illness is successfully and fully defeated by science, instead of taking note and learning the lesson, we think "Oh those weren't really mental illnesses." Some of the most famous examples are hookworm, scurvy, hypothyroidism, and tuberculosis- Yes, we absolutely classified these as mental illnesses. I strongly suspect that in the future, if we ever properly cure bipolar disorder, schitzophrenia, adhd, or CFS, we will instantly forget that we ever believed that they were diseases that lived only in the mind.

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