What if the cure for our current mental health crisis is not more mental health care?

The mental health toll of the Covid-19 pandemic has been the subject of extensive commentary in the United States, much of it focused on the sharp increase in demand for mental health services now swamping the nation’s health care capacities. The resulting difficulty in finding care has been invoked widely as justification for a variety of proposed solutions, such as digital health and teletherapy services provided by profit-driven start-ups and a proposed mental health plan that the Biden administration unveiled this year.

But are we really in a mental health crisis? A crisis that affects mental health is not the same thing as a crisis of mental health. To be sure, symptoms of crisis abound. But in order to come up with effective solutions, we first have to ask: a crisis of what?

Some social scientists have a term, “reification,” for the process by which the effects of a political arrangement of power and resources start to seem like objective, inevitable facts about the world. Reification swaps out a political problem for a scientific or technical one; it’s how, for example, the effects of unregulated tech oligopolies become “social media addiction,” how climate catastrophe caused by corporate greed becomes a “heat wave” — and, by the way, how the effect of struggles between labor and corporations combines with high energy prices to become “inflation.” Examples are not scarce.

For people in power, the reification sleight of hand is very useful because it conveniently abracadabras questions like “Who caused this thing?” and “Who benefits?” out of sight. Instead, these symptoms of political struggle and social crisis begin to seem like problems with clear, objective technical solutions — problems best solved by trained experts. In medicine, examples of reification are so abundant that sociologists have a special term for it: “medicalization,” or the process by which something gets framed as primarily a medical problem. Medicalization shifts the terms in which we try to figure out what caused a problem, and what can be done to fix it. Often, it puts the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.

Once we begin to ask questions about medicalization, the entire framing of the mental health toll of the Covid crisis — an “epidemic” of mental illness, as various publications have called it, rather than a political crisis with medical effects — begins to seem inadequate.

Of course, nobody can deny that there has been an increase in mental and emotional distress. To take two of the most common diagnoses, a study published in 2021 in The Lancet estimated that the pandemic had caused an additional 53.2 million cases of major depressive disorder and 76.2 million cases of anxiety disorder globally.