There is a phrase, a slogan, that I deeply believe in: “no era depresiòn, era capitalismo.” It wasn’t depression, it was capitalism. A phrase that electrified me when I first heard it years ago, during a debate of which I was making a report, that radically changed my view of what I already wanted to do – study to become a psychiatrist – but also, in some way, of the world itself and our life in this capitalist system. This slogan comes from the protests, started by the student population, that shook Santiago, Chile, in 2019, and narrates us a concept that is the subtext of the essay “Psychology of Resistance. Of mental health, change and struggle,” published by effequ.

This book is, in my opinion, not a simple essay, but also a beautiful account of what the taking charge of mental health could be: it creates an imaginary, tells the story of a certain psychology starting from the characters who made this history, moves us and sows a seed of hope, while remaining analytical and in-depth. This is definitely the first thing for which I really appreciated Gianpaolo Contestabile’s work.

A nimble little book in bulk and writing, this four-part volume goes on to investigate, through stories and examples, the close relationship between capitalism and mental health, and the tools that have been collectively developed over the decades to overturn and neutralize this relationship, through certain experiences, particularly in South America.

Giampaolo Contestabile, a doctoral student in Social Psychology in Mexico City and co-founder of “Brigata Basaglia”, starts precisely from the concept of health psychology, born in Cuba during the Guevara-led Revolution, when psychologists began to work not only in psychiatry offices and departments, but also in neighborhoods, in polyclinics, where the approach became one of prevention. By Health Psychology, then, “we refer to how psychological practice can help to improve the prevention and treatment of diseases, to understand what cognitive, affective, behavioral, social, and cultural factors are related to various diseases, and to analyze and improve the health care system.”

An important fact for reading and analyzing our time and society is the increase in chronic-degenerative diseases, which according to epidemiology have supplanted infections, once far more frequent and deadly pathologies. But to understand all the complex facets of these diseases, it is necessary (and I quote here) “to insert the patient’s medical record into his or her personal history, and the latter into History.” It is no longer enough to investigate simple cause-and-effect, pathogen-disease correlations: chronic-degenerative diseases are a challenge for our present because they confront us with the need to assess all those social determinants of disease that instead are increasingly being flattened and, above all, ignored at the systemic level. And this is where health psychology should also come to the rescue, in prevention but especially in the creation of a social and collective concept of health.

The author of the essay does the interesting job of drawing lines that connect the major problems and issues of our world (war, the climate crisis, work, migration, etc.) to mental health, noting how it is not so much psychology that gives us answers in this regard, but rather a certain approach to this discipline, free, open, critical, that allows us to unveil and highlight how it has often been psychology as a science that has reinforced in a negative sense, that has harnessed, these lines, putting itself at the service of Capital.

In the second part, for example, “Of Exploitation,” he draws a straight line between the violence and degrading situations experienced by migrants in CPRs (refugee detention centres) and occupational psychology, that branch of psychology that is concerned with making employees more efficient in their work. On the one hand, the use of a distortion of psychology to mold, by sedating, migrant people, marginalized in CPRs and somehow hidden from the cities, silenced by psychotropic drugs. On the other hand, bodies and minds of exploited workers, in a scenario in which class conflict is also, and especially, flattened by the very means of work psychology, whose purpose is to erase and make more efficient that mental suffering that should instead be the very sign of this class conflict. Occupational psychology teaches to subordinate employees’ mental health to a company’s profits, even more increasingly with the help of automation and artificial intelligence algorithms. A quite different task, in short, from the analytical work of Basaglia and others, which started from the question “If there were no more misery, would psychiatry exist?”

This way of “repairing” mental distress is also the theme of the third part, “Of Catastrophe,” in which Franca Ongaro Basaglia’s words are quoted, referring to the hegemonic medical model: “an organization of hospital care all focused on ‘repair,’ apt to confirm and treat illness as a simple natural phenomenon, unable to interfere in the historical-social process that produces it.” Once again, then, the dominant thinking leads us to think that a therapy will solve all our problems, with mindfulness techniques promising to solve stress, despite the political and economic context in which we live, and leaving it dented the moment we go to ignore the social aspect of psychological suffering.

And from this can only result a sterile automatism in the spaces of psychological care, in which psychologists and psychiatrists and mental health workers in general become mere instruments of “repair,” in which the relationship between individuals and especially with society and its components is annulled. I remember an anecdote that had particularly struck me, recounted by Piero Cipriano, the reluctant psychiatrist, in one of his books. He recounted how he had received a patient who had been brought by the Police to the Emergency Room, and in the interview he realized that the person for whom they were requesting a TSO (mandatory health treatment) for very aggressive fits of rage had been waiting for months for payment for a job he was continually refused. Cyprian’s consideration was that he, too, would be angry, and he wondered why on earth he would have to pump him full of drugs so that he would forget about righteous and motivated anger. I think this very simple anecdote exemplifies a continuing disconnect between clinical practice and social context.

In the light of all that Contestabile recounts in his book, I cannot help but come to a question: is it possible to pursue, in a capitalist world, a social, political, open, sincere, ethical take on mental health, when it is precisely this system of exploitation and oppression that, as we have seen and as Franco Basaglia also teaches us, that most challenges our mental and even physical well-being? Or instead, to truly embrace the idea of a psychology of resistance, is it necessary not only to declare ourselves anti-capitalists, but to integrate anti-capitalism in toto into our clinical practices? For me this is a rhetorical question, but at the same time there is no denying the difficulties and contradictions that open at this point, contradictions that overbearingly then emerge in the experiences, primarily that of Cuba, in which this process of radical struggle has been carried out.

For the author of this book, the answer to this question is also clear and simple: “Militancy against oppression is social medicine. Care work and the struggle for liberation are inseparable. Resistance, including armed resistance, is not only a right and a duty, but also represents a remedy for the suffering of the oppressed.” And so it is that, with many questions and few answers, this book surely brings us to the awareness of how dealing with mental health is one of the challenges of our time, and calls us to face it in perpetual search and questioning, with the humility and curiosity of the Zapatista “walking while asking.”