Introduction

This chapter begins by locating institutional oppression in the English mental health system within its wider sociopolitical and historical context. It does so by introducing the Gramscian notion of the ‘integral state’ to examine the dialectical interaction between the coercive, disciplinary and distributive functions of the capitalist state, and how the counterbalancing of these elements, in particular force and consent, shapes and reshapes welfare regimes over time. It goes on to apply this theoretical lens to a historical overview of forms of mental health provision in England from the Victorian asylum to contemporary neoliberal services. The chapter then explores the social work profession's engagement with these oppressive institutional systems and psychiatric practices, which has ranged from complicity to resistance. This Gramscian mode of analysis is utilised to examine some of the tensions and contradictions underpinning these divergent responses.

Social work, psychiatry and the integral state

The argument to be elaborated in this chapter is that social work's development (like that of psychiatry and other health and welfare occupations) should not be understood in terms of an autonomous ‘professional project’ or a spontaneous response to self-evident human need. Rather, state social work is better understood as a highly context-dependent form of institutional activity, conditioned by the nature of the welfare regime from which it emerges and within which it is situated (Harris, 2008). Moreover, welfare regimes are themselves historically variable, and continually shaped and reshaped by the wider political economy, the requirements of capital and the state and demands from below (Ferguson et al, 2002). The Gramscian notion of the ‘integral’ capitalist state usefully captures the mediatory role of this institutional formation as it seeks to manage these contradictory dynamics and competing pressures in the interests of capital (Gramsci, 1971; Thomas, 2009; Greener et al, 2019). The ‘integral state’ seeks to preserve social order and maintain the relative legitimacy of prevailing class relations (or hegemony) in capitalist society through a combination of securing popular consent and the deployment of force, though consent and coercion are not counterposed within this framework but instead regarded as dialectically interrelated (Thomas, 2009).