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Dancing Through Pain: Capitalist Influences on American Mental Health Treatment and Somatic Alternatives

Updated: Jul 11

By Scarlett Folger

 

Introduction

Capitalism remains a dominant influence on mental health treatment in the United States. The current toolbox of the mental healthcare system promotes a misinformed view that prescribed medications are the only statistically supported mental health intervention. This narrative particularly comes into play in cases of severe illnesses, which the Western biomedical model attributes to endogenous disease processes in the nervous system. Western practice fails to achieve a holistic reflection encompassing biological, environmental and emotional factors. Researchers tend to rely on biomarkers, such as abnormal genes or brain function, despite the reality that many chronic mental health issues require interdisciplinary treatment (Bentall). Western approaches to mental health treatment often view mental illness as a one-dimensional problem to be solved, rather than recognizing its complexity by fully examining the impact of environmental factors or life circumstances. This system is the result of political actors who consistently prioritize profitability over holistic wellbeing. Throughout American history, capitalistic incentives have deprioritized patients and constrained mental health treatment to Western psychiatry, failing to maximize the benefits of alternative somatic interventions.

The Benefits of Western Psychiatry

American mental health professionals typically operate under the assumption that Western medicine is the superior and more controlled medicinal tradition of the modern world (Zhang et al.). Proponents of Western therapeutic practice argue that evidence-based interventions supersede holistic treatments rooted in Eastern medicine (Zhang et al.). This argument encompasses a belief that Western research, diagnostic precision, and pharmacotherapy are more effective than their somatic (body-centered) counterparts, dismissing alternative ideologies as intuitive and irrational. While this argument lacks nuance, empiricism has produced successful outcomes, enabling the development of increasingly effective treatments for various mental health conditions. Western medicine is assumed to rely on rational empirical processes, or evidence-based treatment, while Eastern medicine is less thoroughly substantiated by formal empirical work (Zhang et al.). Methodological rigor ensures that treatments are thoroughly evaluated before prescription and provides clear criteria to ensure the standardization of care (Bentall). Theoretically, this standardization should contribute to more equitable care, as clear protocol and criteria hypothetically eliminate bias and subjectivity in psychotherapeutic evaluation. Supporters of the current healthcare system also point to the integration of pharmacotherapy and psychotherapy, which has gained prominence in the twenty-first century. A more integrative approach should address both psychological and biochemical aspects and allow for a higher level of individualized care, maximizing the therapeutic benefits of pharmaceuticals and the psychological benefits of talk therapies such as cognitive behavioral therapy (Kamenov).

Western psychiatry is characterized by continuous innovation and advancement, leading to the development of new medications, neurostimulation techniques, and evidence-based psychotherapeutic approaches. As the efficacy and accessibility of these therapies increase, there is hope that it will directly improve public health and decrease rates of mental illness, homelessness, and unemployment (Bentall). 

Capitalist Influences on Mental Health Treatment

Capitalist influence is pervasive in all aspects of American society, but is particularly evident in the history of mental health. From poor treatment quality to the overmedicalization of mental health conditions, profit-driven influences have continued to shape our healthcare system. The Moral Treatment Movement attempted to address public stigmatization of mental health, but ultimately gave way to economic pressures. The Diagnostic and Statistical Manual is characterized by its rigid categorical narrative surrounding the mind, which has been criticized for the de-emphasis of the individual patient. Alarmingly high profit rates within the pharmaceutical industry, paired with discriminative workplace culture, has exploited the American public and put a price on wellbeing. By examining these key failures in the moral backbone of American healthcare, we can further investigate the ubiquitous nature of economic influence on our everyday lives and culture.

Mental Health Reform Movements

Prior to the 1800s, care for mentally ill individuals was virtually non-existent. Members of society afflicted by mental illness or who exhibited “deviant behavior” were either relegated to prisons and almshouses or left to struggle with inadequate supervision and resources. Treatment reflected the inhumane medicinal practices of the era, including bloodletting, purgatives, and religious interventions such as exorcisms. Patients were dehumanized and removed from society, further isolating them and inhibiting their recovery (Mandell). In response, the Moral Treatment Movement, widely considered the first mental health reform movement, emerged during the early 19th century. Crusaders such as Dorothea Dix challenged the dominant demonic narrative surrounding insanity and strove to establish safe environments for mentally ill individuals. Dix sought to bring equitable individualized care for patients regardless of socioeconomic status, establishing state-supported hospitals for mental illness treatment in Pennsylvania and New Jersey. The narrative slowly shifted from demonic expulsion to more holistic care. This ideological shift prompted a new wave of mental health research, with more treatments being discovered and implemented (Floyd).

Early psychiatric institutions remained largely true to the ideals of Dorothea Dix, but this waned over time. At first, the 13 superintendents of these institutions, known as “alienists,” were well-educated and engaged advocates in the community. They established the Association of Medical Superintendents and started the American Journal of Insanity, dedicated to studying and emphasizing a more holistic lifestyle. The superintendents lived close to their patients and helped spread awareness by inviting the public in for fundraising programs, promoting a shift in public perception. Instead of being labeled as monsters by the public, patients were seen as “unfortunate fellow beings,” engendering public empathy, albeit misguided (Mandell). During the Moral Treatment Movement, asylums emphasized the role of environmental factors on mental health, promoting the establishment of institutions in rural areas. Removed from stressful environments, patients were provided access to nature, exercise, work, education, and religious teachings, highlighting the efficacy of holistic treatment (Floyd). However, after the collective trauma of the Civil War, faith in moral treatment waned. Demand for physical and mental health treatment soared, and the cost of institutions became unsustainably high, worsened by the government’s curtailing of funds. The public became increasingly disillusioned with mental health experts due to an overestimated curability rate and consequent failure of treatments. Additionally, an influx of immigrants during this period exacerbated issues of overcrowding and lack of fee-paying private patients (Floyd).

Faced with budget cuts and reallocation of funds, mental institutions in the 20th century maximized profitability at the expense of quality. Superintendents and practitioners had retired and were replaced with uninspired and under-qualified political appointees. The subsequent alienists were increasingly isolated from the public, creating a sense of dissonance between the patients and doctors. This dehumanized the mentally ill and increased public fear surrounding mental illness and institutionalization. This fear drove a return of the outdated ideology initially targeted by the Moral Treatment Movement. Principles of social darwinism, including the “survival of the fittest” doctrine, re-emerged and gained traction in the early 20th century (Floyd). Resultantly, treatment was further medicalized, and inhumane practices were reinstated including the use of physical restraints, tranquilizers, and bloodletting. Social darwinism further stigmatized mental illness and led to wide-spread denial of mental health care (Mandell). Due to the rigid attitudes towards mental health at the time, in addition to funding issues in asylums, conditions continued to deteriorate. 

In response to the downfall of Moral Treatment, another mental health reform movement emerged in a renewed commitment to deliver better care. In the early 1900s, Clifford Wittingham Beers, a Yale graduate, suffered repeated extreme episodes of depression and anxiety. Beers was institutionalized and experienced first-hand the maltreatment and abuse that occurred in private institutions. Beers critiqued the decreasing efficacy of these institutions, including hiring cheaper labor, less qualified physicians, and overlooking blatant evidence of abuse (“Our History”). Beers sought to change the nature of mental health treatment by prioritizing individuals. In pursuit of this goal, Beers founded the Connecticut Society for Mental Hygiene and the American Foundation for Mental Hygiene, in addition to other international committees. To raise awareness, Beers published an autobiography, A Mind that Found Itself, which served as a call to reform mental health treatment (Tolan et al.). Over time, the movement expanded to address preventative measures and environmental factors impacting public health. While Beers’ precedent of individualized care fueled a new perspective in psychiatric discourse, the early Mental Hygiene Movement aligned with the goals of psychiatrists, who were taught to follow a more rigid psychoanalytic approach. Consequently, the treatment of “insanity” and “mental deviance” was prioritized (Floyd), while other emotionally debilitating conditions, such as depression and anxiety, were largely ignored during this period (“Our History”).

The downfall of the Moral Treatment movement was driven by economic considerations, highlighting the pervasive influence of capitalism in shaping mental health care while reinforcing the social stigmatization of mental illness. Despite the advocacy of mental health crusaders such as Dorothea Dix, lack of profitability ultimately killed the Moral Treatment effort. The prioritization of economic feasibility soon overcame the demand for environmentally-focused therapies, leading to decades of abusive treatment with little governmental oversight. These failures in the healthcare system point to the direct influence of capitalism, which has fostered societal ignorance of the plight of the mentally ill - an attitude that prevails in American culture today. A 2020 Mental Health America study found that over 20% of adults in the US experience a form of mental illness, with over 1 in 10 youth experiencing debilitating depressive episodes (Reinert et al.). The demand for holistic treatment is evident, yet difficult to prioritize given the competing demand for profit. These startling statistics reflect the lack of alternative mental health resources available and a failure in our educational system to equip youth with proper life skills to manage anxiety and depression. This again points to capitalist influence in our political system. Corporate greed, poor allocation of funds, and socially conservative politicians control public education and have the power to directly prevent the education of life-saving information on topics crucial to mental health, such as sexual safety, and healthy emotional expression, as exemplified by controversial Florida bill HB 1557 (“The Dangerous Consequences of Florida’s ‘Don’t Say Gay’ bill on the LGBTQ+ youth in Florida”).

The Rise of the DSM

The pervasive impacts of capitalism can also be found in the fabric of our diagnostic process, which is still primarily based on the Diagnostic and Statistical Manual, or DSM. As the most crucial resource for the diagnosis and assessment of mental illness, the DSM has been revised five times since its conceptualization in 1952. Published by the American Psychiatric Association, the creation of the DSM was driven by the pressing need to better understand and address mental health issues, particularly in the wake of World War II and its subsequent consequences to public health. The World Wars expanded the domain of psychiatrists from patients considered clinically insane to society at large. Post-traumatic stress disorder (PTSD) was prevalent among soldiers who returned from the war, and many struggled to reintegrate into civilian life. The symptoms of PTSD, then known as “shell-shock,” interfered with veterans’ ability to work, maintain relationships, and function effectively in society. Reintegration issues affected not only soldiers, but also their families and communities. The urgent need to address the mental health issues of returning veterans pushed the demand for standardized diagnostic criteria to the forefront of psychiatry. The DSM aimed to provide clinicians with tools to accurately and consistently diagnose servicemen (“Controversy over DSM-5”). Its successive editions have governed how mental illness is evaluated, classified, and treated.

Despite the largely positive impact of the DSM, the motives driving its creation emphasize the involvement of capitalism in psychiatric breakthroughs. Progressive psychiatrists argue that the current DSM exhibits a clear tendency to over-diagnose or misdiagnose mental disorders, directly lining the pockets of pharmaceutical corporations. The DSM has faced this criticism before, leading to category updates amid controversy in 2013. More radical experts in the field prefer to move away from distinct categories and toward a more dimensional concept of mental illness, suggesting treatment plans and diagnosis should be grounded in research data as opposed to symptom-based categories. Critics of the DSM also cite a history of mischaracterizations throughout its development, including the listing of homosexuality as a “sociopathic personality disorder” and the labeling of autistic spectrum disorders as a form of childhood schizophrenia. An article published by the Nursing Times claims the DSM-5 demonstrated an “unhealthy influence of the pharmaceutical industry on the revision process,” citing the rising inclination to “medicalize” behavioral patterns that are generally accepted as mild. The DSM-5 taskforce was undeniably biased in favor of Big Pharma, as over 67% of the committee had direct ties to pharmaceutical companies (“Controversy over DSM-5”). While cooperation between research and industry is to be expected, lack of governmental regulation over pharmaceutical prices does little to mitigate the effects of corporate giants on public health research. Consequently, the influence of pharmaceutical incentives subtly exaggerated the significance of certain symptoms in the diagnostic tool, leading to further backlash for medicalizing patterns of behavior and mood (“Controversy over DSM-5”). 

An open letter, followed by a petition published by the Society for Humanistic Psychology, drove the issues of the DSM-5 to the forefront of the psychiatric community. Their letter stated that psychiatrists were “concerned about the lowering of diagnostic thresholds for multiple disorder categories” and the “introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations.” Additionally, the letter calls into question the lack of empirical grounding for specific proposals (“Open Letter to the DSM-5”). Following the frenzy of the open letter, Professor Allen Frances wrote a number of high-profile articles emphasizing ten changes to the manual he considered blatant overmedicalization. Frances was the chair of the taskforce for the previous 1994 update DSM-IV, and his disapproval of these changes underscores the flawed “top-down” approach to mental healthcare in which patients are often made to “fit” the standards of a diagnosis, regardless of the usefulness of this diagnosis in treatment or symptom management. Examples of this medicalization include diagnosing grieving individuals with major depressive disorder. Widely accepted as a healthy human experience, grief requires healing environmental therapies, not antidepressants. Additionally, individuals struggling with “everyday worries” are dangerously misdiagnosed and unnecessarily treated for conditions like generalized anxiety disorder (“Controversy over DSM-5”).

Professor Frances ultimately defends the manual’s importance, stating that while “despite all its epistemological, scientific and even clinical failings, the DSM incorporates a great deal of practical knowledge in a convenient and useful format.” Clearly, the DSM is integral to American healthcare. However, its shortcomings are indicative of the damaging influence of capitalism on mental healthcare. Given the ramifications for patients, the DSM’s limitations must be addressed properly.

Modern Influences on Mental Health Treatment

Healthcare in the United States is unethically profitable. A 2022 report of the National Health Expenditures Accounts estimated that the total US spending on healthcare eclipsed $4.5 trillion, accounting for 17.3% of the country’s gross domestic product. Insurance and pharmaceutical companies occupy the lionshare of this spending, and they rely on a lack of governmental regulation of pricing in increasing their profit margins. The primary interest of the pharmaceutical industry is not the wellbeing of the individual, but the generation of exorbitant profit. The industry has faced accusations of fabricating the significance of certain diseases with the aim of marketing their “miracle cure” (Zhang et al.). Despite the spike in revenue that pharmaceutical companies have enjoyed in the past two decades, patient outcomes for severe mental illness have not drastically improved as a result of the increase in drug prescriptions. These paradoxical findings emphasize the role of capitalist culture in mental health, as patients receiving psychiatric services in industrial societies have worse outcomes than patients receiving minimal treatment in the developing world (Bentall). While industrial world treatments for physical conditions have vastly improved, our understanding of the mind is still quite limited. Research and technical skill allow for high success rates in the diagnosis and treatment of physically presenting conditions, such as heart disease and cancer, but fall short in our assessment of mental disorders (“Controversy over DSM-5”).

Capitalist culture in the American workplace contributes to a hyper-competitive narrative of success, leaving employees to face mounting pressures without sufficient resources. Discrimination in the office underscores how capitalism exploits the mental health of the working class in favor of profitable interests. Examples include unjust terminations, microaggressions, and fewer promotions for individuals who share about their struggle with mental illness or receive treatment. The absence of mental health coverage has been a key form of systemic discrimination in the US (Kokorikou et al.). The perpetuation of productivity culture in America accommodates the capitalist influences on our healthcare system, as opposed to challenging it or reconciling it with other effective practices. A 2023 National Library of Medicine article claims that “[companies] may condemn stigmatization along some axes of identity (e.g., condemning sexism), but continue to stigmatize identities associated with impaired productivity and class.” Consequently, individuals with “invisible” disabilities, such as mental health conditions, are susceptible to mischaracterization as “free-riders” in market societies. This stigmatization is particularly degrading in capitalist societies, as the economic structure “relies on discrimination to exploit segments of the workforce and reduce production costs” (Kokorikou et al.). This winner-takes-all mentality in American professionalism fosters a manipulative norm of overwork across career paths and fails to recognize the role of culture and environment in emotional welfare.

Alternative Somatic Interventions

Capitalistic values have focused Western mental health treatment solely on the mind, driving a societal disconnect from the body and thereby limiting potential treatments to those that are understood and replicated within Western medicine. Holistic interventions, which address both mind and body, are essential to progressing the treatment of mental health and improving public health overall. Though they have not been empirically studied to the extent of pharmaceutical interventions, body-centered somatic therapy and dance therapy are effective options for mental health treatment and maintenance.

Historical Disconnect from the Body

A myriad of movement practices, such as swimming, running, and team sports share the potential for mood enhancement. However, improvisational movement derives a unique benefit: an increase in mindfulness and connection to the body. These effects parallel those of yoga, which has been practiced for thousands of years and become integral to spirituality and health in many Eastern cultures. Humans “have used dance for purposes of expression, social bonding, and spiritual-emotional healing since prehistoric times” (Laird).

Our disconnect from this ancient practice stems, in part, from the societally-driven disconnect from the body, or soma. Richard Strozzi-Heckler, a somatic coach, argues that most people embody “unconsciously inherited” lives and are “mimicking patterns of living that have been passed on to us by family, school, religion, government, economic institutions, and the media” (Strozzi-Heckler). In Western culture, capitalism shapes all aspects of our professional lives. This in turn begins to impact our personal lives, as those who sacrifice their privacy and time are rewarded by the machine of capitalism. Whether it be a promotion, a new job, or a new business endeavor, individuals are increasingly incentivized to reach beyond their comfort level to pursue greater ambitions (Kokorikou). In America, realized ambition equates to success, which in turn equates to happiness and fulfillment. 

According to Strozzi-Heckler, the “contemporary interpretation of the body” stems from the 17th century French philosopher, René Descartes. Philosophizing during a time of war, religious upheaval, and conspiracy based on superstition, Descartes attempted to assuage the chaos by “providing certainty through rational means.” Also known as Cartesian thinking, Descartes’ philosophy helped to free individuals from theological quandaries and crises of witchcraft. “His philosophy became the basis for the fundamental assumptions of scientific thought as we know them today,” Strozzi-Heckler asserts. This ideological transformation shifted the domain of power from the Church to the institutions of knowledge. Centuries of religious convictions were slowly disproved by the “promises” of science. The ensuing Scientific Revolution resulted from this transformation of thought and further compartmentalized the domains of science and spirituality. In this classification, the body became a detached organism to be scientifically studied. The distancing of the physical body and spirit stripped Western culture of a crucial spiritual practice: mindfulness (Strozzi-Heckler).

The prioritization of rationalism and capitalism in Western thought, compounded by pharmaceutical influence and limited resources approved by insurance, has constrained mental health treatment options, perpetuating a narrow path of diagnosis and treatment that neglects the holistic integration of mind and body. Descartes “removed the body from Western philosophy in one clean cut…saying emotions, feelings, and sensations happen to us, and we must learn to ignore or dominate them in service to what is rational,” Strozzi-Heckler claims. This school of thought began a Western tradition of “conquering the body” rather than working through the body in medicinal practice (Strozzi-Heckler). Rationalism and capitalism, in combination, shaped psychiatry research into a relatively homogenous path of diagnosis and treatment limited to what scientists can statistically claim as beneficial. This narrows the possibilities of mental health treatment and restricts patients to what is available and covered by insurance, perpetuating this prioritization of practicality over patient wellbeing. Additionally, the overprescription of antidepressants and other mental health related drugs is promoted by pharmaceutical corporations, as drug companies take advantage of Pharmacy Benefit Managers to “discreetly offer financial inducements in order to gain PBMs’ favor during insurance coverage determinations” (Kennedy). Practitioners also refrain from prescribing certain medications due to lack of insurance coverage. Consequently, individuals struggling with chronic health issues are often prescribed the cheapest, most frequently used medications and denied newer or more specialized treatments. Though forms of mind-body treatments have thrived for centuries in Middle Eastern, Asian, and Indigenous cultures, the integration of these practices into Western civilization did not emerge until the 1930s through the work of Wilhelm Reich, a student of Sigmund Freud. Reich believed that neurosis resided in the body and could be resolved through direct body work, using practices engaging touch, breath, and gesture (Strozzi-Heckler). In the ensuing decades, the field of somatics grew, shifting toward a “healing modality of physical and emotional health,” as Strozzi-Heckler describes.

Benefits of Movement Therapies

The health benefits of movement therapies are substantial. In a 2021 study done by UCLA Health, it was discovered that “Conscious Dance” significantly improved participants’ moods and reduced symptoms of stress-related health conditions such as addiction, depression, and anxiety. In this study, Conscious Dance is defined as “unchoreographed, non-evaluative mindful movement.” Out of 1003 conscious dancers, over 95% of those who struggled with mental health reported therapeutic benefits. A systematic review of the psychological benefits of dance, published in the National Library of Medicine, reports that “dance movement therapy demonstrated positive improvements in the symptoms such as somatization…depression, anxiety, paranoid ideation, and psychoticism.” Psychological symptoms such as fatigue, stress, and insomnia are directly linked to circulating levels of serotonin and dopamine. According to the review, “increased plasma serotonin concentrations and decreased dopamine concentrations indicate possible therapeutic benefits for the decreases in depression observed.” In addition to emotional stabilization, dance therapy has been shown to improve executive function (including memory capacity) in developmental years, can serve as preventative treatment for poor health and wellbeing, and improves academic performance. Music contributes to these benefits, creating a “pleasurable sense” while dancing and improving motor stimulation, as exemplified by the skill of synchronization. Additionally, group dance movement therapies help participants build emotional awareness and social skills, while the collaborational aspect of dance improves convergent thinking skills (the process of solving problems) (Tao et al.).

Despite a lack of awareness of movement based therapies, new studies continue to highlight their potential. A randomized controlled trial in Sweden investigated the efficacy of a dance-based intervention for adolescent girls, with overwhelmingly supporting results. The trial provided an after-school dance program for 112 participants aged 13 to 18. The intervention directly targeted adolescents with stress-induced somatic symptoms and emotional distress. Symptoms included chronic physical pain such as headache, fatigue, and stomach pain, in addition to emotional symptoms such as sadness and anxiety. The study’s focus on “enjoyment and socialization” helped foster a uniquely accepting and positive environment specifically for teens who struggle with health issues. After the 8 month intervention period, the experimenters administered a questionnaire to evaluate short-term benefits. The questionnaire was re-administered at 12 and 20 months to evaluate long-term effects. The results showed a significant reduction in somatic symptoms and emotional distress in the intervention group as opposed to the control, with the greatest point of difference found at the post-intervention follow ups. The authors further theorize that “understanding stress and its somatic consequences is a prerequisite for developing effective therapeutic strategies'' that individuals can deploy on their own (Duberg et al.). While the study was the first to evaluate the efficacy of dance to target somatic symptoms, the results of the study are in line with data from the Bristol Girls Dance Project, an after-school dance intervention aimed at tween girls (Jago et al.). These two studies emphasize the importance of music, physical activity, and social connectedness in mental health. This suggests that dance carries immense potential as a form of mental health treatment, and more classes focused on these methods would benefit public health overall.

Dance also represents an intervention that is relatively feasible to implement. The NLM systematic review suggests that developing dance-based physical education in school curricula could provide numerous benefits to students at a relatively low cost to the school. The review states, “[s]chools are in a unique position to provide healthy and academic outcomes via the implementation of health and wellness policies.” Dance is versatile, adaptable to solo or group settings, and can be enjoyed in any spacious environment without need for specialized gear. Many public health issues are exacerbated by failures in public education. Without awareness of mental health issues, students are increasingly exposed to depression and anxiety without adequate knowledge about effective, low-cost methods of treatment (Tao et al.). Access to equitable resources should be ingrained in education to support student health. 

Conclusion

Capitalist values are deeply ingrained in American society and shape the landscape of mental health treatment, resulting in the dismissal of effective holistic approaches such as somatic interventions. The history of treatment in America reveals these capitalist influences on the decline of institutional treatment, prioritization of productivity, and rise of overmedicalization. Though Western treatment has found some success in abating mental health struggles, alternative body-centered treatments such as dance therapy are crucial to improving public health in Western societies. By extending these resources to schools, community centers, and workplaces, we can raise awareness of the therapeutic efficacy of somatic therapies, making mental health treatments more accessible and affordable for all. 



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