Dynamics In Quantifying Human Unhappiness
The Article: The Political Economy of Unhappiness by William Davies in the New Left Review.
The Text: For the majority of its history, Britainâs National Health Service has scarcely ever considered the specific health needs of working people, other than those of its own staff. Almost by definition, the NHS was originally dedicated to supporting people who were outside of the labour marketânew mothers, children, the sick, the elderly and the dying. British doctors issued âsick notesâ, certificates that were given to patients, informing their employers that they were unable to work. But in recent years policy-makers have begun to challenge these assumptions, along with the binary split between health and illness, economically productive and economically needy, on which they rested. In 2008, a review of the health of Britainâs working-age population was published jointly by the Department of Health and the Department of Work and Pensions. Most strikingly, it calculated that the annual cost to the British economy of health-related absence from work was ÂŁ100bn, only around ÂŁ15bn less than the entire cost of the NHS.
âWellbeingâ provides the policy paradigm by which mind and body can be assessed as economic resources, with varying levels of health and productivity. In place of the binary split between the productive and the sick, it offers gradations of economic, biological and psychological wellness. And in place of a Cartesian dualism between tasks of the body and those of the mind, blue and white collar, proponents of âwellbeingâ understand the optimization of mind and body as amenable to a single, integrated strategy. One of the leading influences on the UK governmentâs work and wellbeing programme, Gordon Waddell, is an orthopaedic surgeon whose book The Back Pain Revolution helped transform policy perspectives on work and health. Contrary to traditional medical assumptionsâthat ârest and recuperationâ are the best means of getting the sick back to workâWaddell argued that, in the case of back pain, individuals could recover better and faster if they stayed on the job.
Waddellâs findings suggested that, even where work is primarily physical, medical and economic orthodoxy had underestimated the importance of psychological factors in determining health and productivity. Being at work has the psychological effect of making people believe themselves to be well, which in turn has a positive effect on their physical wellbeing. Hardt and Negri argue that, while âimmaterialâ or âcognitiveâ labour still only accounts for a small proportion of employment in quantitative terms, it has nevertheless become the hegemonic form of labour, serving âas a vortex that gradually transforms other figures to adopt its central qualitiesâ. Waddellâs work is a case of this transformation in action. The emerging alliance between economic policy-makers and health professionals is generating a new consensus, in which the psychological and âimmaterialâ aspect of work and illness is what requires governing and optimizing, even for traditional manual labour. In place of the sick note, a new âfit noteâ was introduced in 2010, enabling doctors to specify the positive physical and mental capabilities that a patient-employee still possessed and which an employer could still put to use.
There was another, more urgent reason for the new policy paradigm. As labour has become more âimmaterialâ, so has the nature of health-related absence from work. Some ÂŁ30â40bn of the annual ÂŁ100bn lost to the UK economy through health-related absence was due to mental-health disorders. Around a million people in the UK are claiming incapacity benefit due to depression and anxiety. Figure 1 indicates the gradual âdematerializationâ of incapacity over recent years. The turn towards âwellbeingâ, as a bio-psycho-social capacity, enables employers and healthcare professionals to recognize the emotional and psychological problems that inhibit work, but also to develop techniques for getting employees to improve their wellbeing and productive potential. Even more than back pain, mental illness is considered to be better treated by keeping people in work, than absenting them from it. In contrast to a neo-classical or utilitarian perspective, which would treat work as the opposite of utility, many economists also now argue that work is a positive force for mental health, and that unemployment causes suffering out of any proportion to the associated loss of earnings.
Depressive hegemony
Depression is the iconic illness in this respect. Indeed, we might say that if âimmaterialâ labour is now the hegemonic form of production, depression is the hegemonic form of incapacity. Typically, depression is characterized by a lack of any clear clinical definition; indeed it is often defined as anything that can be treated with anti-depressants. Depression is just sheer incapacity, a distinctly neo-liberal form of psychological deficiency, representing the flipside of an ethos that implores individuals to act, enjoy, perform, create, achieve and maximize. In an economy based in large part on services, enthusiasm, dynamism and optimism are vital workplace resources. The depressed employee is stricken by a chronic deflation of these psycho-economic capacities, which can lead him or her to feel economically useless, and consequently more depressed. The workplace therefore acquires a therapeutic function, for if people can somehow be persuaded to remain in work despite mental or physical illness, then their self-esteem will be prevented from falling too low, and their bio-psycho-economic potential might be rescued. Many of the UK governmentâs strategies for reducing incapacity-benefit claims and health-related absence focus on reorienting the Human Resources profession, such that managers become better able to recognize and support depressed and anxious employees. Lifting the taboo surrounding mental illness, so as to address it better, has become an economic-policy priority.
In the early 1990s, the study of the psychological effects of unemployment was the catalyst for a new and rapidly expanding branch of neo-classical economics: happiness economics. Together with the concept of wellbeing, happinessâsometimes referred to as âsubjective wellbeingââprovides policy-makers with a new analytical tool with which to measure and govern economic agents. It represents one prominent attempt to cope with the âcrisis of measureâ that arises when capitalismâs principal resources and outputs are no longer solely physical, yet still require economic quantification in order to be valued. At an aggregate level, concern for the happiness of entire nations, and the failure of economic growth to improve it, has inspired political leaders to demand new official âindicatorsâ of social and economic progress, which account for this intangible psychological entity. President Sarkozyâs âStiglitz Commissionâ on the measurement of national progress made headlines around the world, while the Australian, American and British statistical agencies are already collecting official data to track national happiness levels. The gap between growth in material and psychological prosperity, known as âEasterlinâs Paradoxâ after a 1974 article on this topic by economist Richard Easterlin, is soon to receive official endorsement.
Unhappiness has become the critical negative externality of contemporary capitalism. In addition to the policy interventions already mentioned, the New Labour government introduced an Increasing Access to Psychological Therapies (iapt) programme, to make Cognitive Behavioural Therapy more widely available via the NHS. Richard Layard, an economist at the London School of Economics appointed by Blair as the UKâs âhappiness tsarâ, stressed the economic significance of this programme, urging that it be expanded further in response to rising unemployment. The sheer inefficiency of depression, and the efficiency of CBT in tackling it, is demonstrated by Layard in a paper making the âbusiness caseâ for spending more public money on talking cures. CBT, and policy enthusiasm for it, is controversial amongst psychotherapists and psychologists, many of whom view it as a âsticking plasterâ which conceals mental illness, at best for limited periods of time. Yet, by virtue of being clearly time-limitedâa course of CBT can last a mere six sessionsâand output-oriented, it is amenable to an economic calculus in a way that traditional psychoanalysis or psychotherapy are patently not. Programmes for getting unemployed people back to work in the UK now offer CBT courses, in an effort to re-inflate their desire to overcome economic odds.
Thinking pleasure