Democracy and mental health ‐ a psychoanalytic contribution
| Published date | 20 April 2009 |
| Date | 20 April 2009 |
| DOI | https://doi.org/10.1108/17465729200800018 |
| Pages | 8-14 |
| Author | Mark Cohen |
| Subject Matter | Health & social care |
8journal of public mental health
vol 7 • issue 3
© Pavilion Journals (Brighton) Ltd
While the literature examining
the re lati on b etwe en s ocia l
factors and health is extensive
(Marmot, 2004; Wilkinson,
2005), consideration of the
relation between political structures and health
is quite limited in the medical or public health
literature (Borrell et al, 2007; Wise & Sainsbury,
2007). There are some studies examining the
relation between political systems and health
(Franco et al, 2004; Ncayiyana, 2004; Shandra et al,
2004), as well as reflections on the philosophical
and ethical questions raised (Ruger, 2004, 2005;
Sen, 2005). Navarro and Muntaner (2004) and
other authors refer to the importance of political
factors when considering related subjects such as
social capital (Coburn, 2000; Szreter, 2002). There
is literature linking democracy and better public
health, although the evidence is limited to studies
of quite crude general measures (Franco et al, 2004;
Navarro et al, 2003; Safaei, 2006). The limited
evidence suggests a positive correlation between
democracy and public health.
Democracy
Democracy is a term that is now met with almost
universal approval and yet, within that, the nature
and extent of governing for and by the people is
open to considerable difference and debate. Robert
Dahl (2005, 2006) has, in recent publications,
formulated the notion of an ideal democracy on a
large scale. He suggests that in this form, democracy
is an ultimately unachievable but worthwhile
aim. He outlines a number of factors that would
be required to meet the conditions for the ideal
democracy. These include free, fair and frequent
elections, associational autonomy and an inclusive
citizenship. Referring to the liberal economies of the
West, he notes that while such economic systems
are supportive of democracy to a certain degree
or a particular form, they also invariably result in
economic and political power being concentrated
in the hands of elites.
Although Dahl (2006) focuses on the US, his
point has a relevance to other liberal democracies
in which there are significant economic inequalities
(Brewer et al, 2007). It is apparent that measures,
which, in general, foster a more egalitarian society are
in keeping with moving towards the democratic ideal.
Other authors attempt to address the detail of
the political process in a democratic system and
the enormous difficulties of promoting genuine
democracy in large groups, societies, countries or
globally (Fung & Wright, 2003; Cohen & Fung,
2004; Monbiot, 2004). Reviewing the history and
practice of democracy and by studying small-scale
democr atic proce sses, Mans bridge (19 80) argues
that democracy has largely become dominated
by an adversarial system in which individual
interests seek to be met. She notes that this was not
ANALYSIS
Mark Cohen
Consultant
Psychotherapist
NHS Greater
Glasgow and Clyde
Correspondence to:
Mark Cohen
Consultant
Psychotherapist
NHS Greater
Glasgow and Clyde
Carswell House, 5
Oakley Terrace
Glasgow G31 2HX
Key words:
mental health;
democracy;
politics;
psychoanalytical
perspective
In this paper, the author comments on the influence of political structures on public mental health.
Using psychoanalytic theory and a Kleinian framework, the author suggests that current political
systems and culture can be inhibiting of mental development and health. The paper explores the
concept of democracy as an ideal and the effects it has on public mental health. The paper raises the
question of political restructuring as a means of promoting mental health and suggests that there is
a role for further interdisciplinary work in this area.
Democracy and mental
health – a psychoanalytic
contribution
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