A reporter from the BBC recently interviewed a Cuban psychiatrist about the innovative treatments being employed at his hospital. She asked him why, given that so many neuroses and psychoses result from living under capitalism, people develop mental illness in Cuba. This was bait. No doubt she expected him to say that because the revolution was not yet complete, and a Communist world order had not yet been achieved, lingering mental illnesses were bound to arise from social conditions that did not yet fully reflect man’s recognition of man. Instead, the Cuban psychiatrist gave a sober response. He replied that schizophrenia, for instance, is the same everywhere, but that it takes different forms depending on the social context. He gave the example of a delusional patient who was convinced that he was a heroic guerrilla fighter, commenting that in the US such a patient might fancy himself a millionaire or a CEO. This difference, however, did not make one man healthier or sicker than the other.

The answer given by the Cuban doctor seems to contradict recent bourgeois ideology on mental illness that has influenced some thinking on the subject from the left. Some discussions about depression have been particularly cavalier and irresponsible. The thinking goes that treatments for depression serve to reconcile the patient to an exploitative and oppressive society, and that to be “healthy” or “happy” in a sick and depressing society is not to be healthy or happy at all. Though it has its source in bourgeois self-loathing, this ideology also seems to have support in certain strains of Marxist literature (particularly the writings of Marxist cultural critic Herbert Marcuse). Here, the insistence is that psychological problems cannot be divorced from political or social problems, and that it is not enough to cure the mentally ill by preparing them to become docile fodder for the economic system. But there is no need to move from this position to the conclusion that to treat mental illness clinically and scientifically means to give in to the status quo.

The chief problem under capitalism is not that people are getting treatment for mental illness and reconciling themselves to capitalism. It is that people cannot afford, or do not have access to, quality treatment that can enable them to lead a life that is productive (not only economically, but socially, politically, culturally and emotionally). It would be romantic and utopian to believe that mental illness will disappear under Communism. In fact, it seems likely that the number of diagnosed and treated cases would go up. This does not mean, of course, that we should temper our criticism of a psychiatric establishment whose every facet is subservient to the demands and logic of the capitalist market. It does mean, however, that these criticisms should be directed toward the establishment of better, more comprehensive and more creative methods of treatment, not toward the abolition of psychiatric care itself.

This is the direction in which Cuba is moving. The BBC interview centered on using active participation in the performance of Cuban music, in addition to more standard medical techniques, to treat long-term patients.