- A new book recommends a fundamental reorientation of our thinking about mental health.
- It's possible that pathologizing our mental health problems obscures their deeper sources.
- We need to better confront the economic and political structures that make us sick.
Since the 1980s, it’s been increasingly popular to see mental illness as a “chemical imbalance” of the brain, one that should be treated with medication or psychotherapy. But what if our distress is a perfectly normal response to a society that’s lost its way? What if unfettered capitalism is making us sick?
I spoke with Dr. James Davies, Associate Professor of Medical Anthropology and Psychology at the University of Roehampton, London, and a practicing psychotherapist. He’s the author of the provocative book Sedated: How Modern Capitalism Created our Mental Health Crisis (Atlantic, 2021). It offers nothing less than a fundamental reorientation of our medical thinking about mental illness. Our conversation is below.
Justin Garson (JG): In your last book, Cracked, you explored specific ways that the pharmaceutical industry infiltrates psychiatry. (For example, I hadn't realized before reading your book that over half of the members of the task force of the DSM-5 have ties to the pharmaceutical industry.) But in Sedated, you take on a much larger foe: capitalism. Why the shift?
James Davies (JD): Well, I wanted to try and understand how bio-psychiatric interventions and ideology have continued to expand and dominate contemporary mental health provision, despite their presiding over poor or worsening clinical outcomes. If an institution is failing on such a large scale, as the evidence suggests bio-psychiatry has been doing, you’d expect that social institution to either disband or dramatically reform. But neither happened.
Cracked explored the role that the pharma industry has played in keeping a clinically compromised system afloat, largely out of self-interest (the global psychiatric drug market is worth over $30 billion annually). But for me, the story does not end there. After all, why have financial interests been allowed to determine the direction of our mental health care sector, especially in ways that haven’t served the public interest?
Sedated attempted to take a wider sociological perspective and identify the hidden mechanisms that have enabled our medicalized system to expand and thrive despite its failing on many important outcome metrics.
JG: Of course, capitalism is an economic system that's been in existence in various forms for at least a few hundred years. You suggest that there are specific changes that took place around the 1980s that help to explain soaring rates of mental illness in the last 40 years. Could you say more about those specific changes?
JD: In the 1980s under Ronald Reagan in the U.S., and Margaret Thatcher in the UK, a new species of capitalism emerged which radically changed the nature of political economy. This style has been dubbed "late capitalism," "deregulated capitalism," or, more recognizably, "neoliberalism"; it's a style that significantly departed from the more socially democratic forms of capitalism dominating post-war society.
Neoliberalism greatly expanded the dominance of market forces through deregulation, privatization, and regressive forms of taxation, while significantly reducing the state’s role in the economy through cuts to labor, welfare, and social protections.
Behind these economic reforms sat a new idea of what constitutes a good and free society—a concept about what direction we should all be striving in to become the best versions of ourselves. In the new neoliberal era, then, success would be reframed as a product of having exceptional individual qualities (rather than exceptional social privileges and advantages), while failure would be rooted in some kind of personal deficit (rather than in lack of opportunity, equality, or social support).
JG: A core claim of your book is that capitalism both “depoliticizes and commodifies” our suffering. Could you say a bit more about what it means to depoliticize suffering?
JD: In the book I define "depoliticization" as the process by which suffering is conceptualized in ways that protect the current economy from criticism—namely, as rooted in individual rather than social causes, which means we must favor self over social reform.
One example of depoliticization that I offer in the book concerns the terrible epidemic of farmer suicides that blighted Central India between 2000-2010, about which China Mills has written. At this time, multinational agricultural companies were trying to create new markets in India for their products, and they were doing so by replacing the traditional crops that the farmers had always used with genetically modified plants that didn’t produce any seeds.
This meant that local farmers could no longer save their seeds for next year’s crop (as they’d always done) but now had to buy expensive new plants each year from the multinationals, which put many into crushing debt and poverty. As a result, thousands of farmers were killing themselves under the resulting stress, mostly by drinking toxic pesticide.
But in the face of these terrible suicides, rather than challenge the multinationals, the Indian state sent in teams of psychiatrists and psychologists to tackle what was now being framed as a "mental illness epidemic." It also launched a campaign, with the World Health Organization, to make antidepressants more freely available to the farmers; a campaign that was also partly funded, it turns out, by these very agricultural companies.
In other words, the solution to the suicide epidemic was psychiatric rather than political. "Nowhere was suicide seen as a desperate response to a situation made unbearable by the multinationals," as China Mills put it.
This misuse of the mental illness narrative I think illustrates the essence of how depoliticization works: It effectively turns socially caused problems into internal dysfunctions, making the "self" the site of reform and thereby exonerating harmful social, corporate, or political arrangements and so by implication, helping nullify in people the forces that push for social change.
JG: It probably isn’t hard for readers to see a connection between the materialism and hyper-individualism of the modern West and spiraling rates of anxiety and depression. Do you think your book can help us think about more serious mental illnesses such as schizophrenia or bipolar disorder? Is psychosis a “sane response to an insane society”?
JD: There is an abundance of research demonstrating that we are more prone to experiencing extreme emotional states if we’ve suffered various social, relational, or situational harms. To suffer in response to extreme abuse, trauma, or oppression is not to suffer from pathology. It’s to suffer from being human.
And humans suffer in multifarious ways. Much of this suffering, even in its extreme forms, can turn out to be functional if we care to look deeply enough: It may be a call to change, or the organism’s protest against what is harming us or holding us back, or the inevitable outcome of waking up psychologically. Such functional suffering, in my experience, is highly liable to become "dysfunctional" if it is misunderstood or mistreated or wrongly pathologized/stigmatized.
JG: I was a bit surprised that in Sedated, in addition to drug companies, you also criticize mental health interventions such as CBT and popular slogans like "psychological resilience." In what ways do you think these psychological interventions continue to depoliticize and commodify suffering?
JD: Well CBT (certainly as it is being implemented in the NHS in the UK) is perfectly consistent with the depoliticizing and individualizing trends that serve the neoliberal status quo, which replace social reform with self-reform. If you suffer, the fault resides within you, and so too does the solution: You need to learn how to think, feel, and act differently.
We see something structurally similar with the chemical imbalance ideology. Again, there’s a dysfunction within you that needs to be corrected, now with a pill, so forget your social context. If you suffer from working a "bullshit job," well then, change your attitude. If you are going crazy from sitting for five hours a day in a classroom, well, off you go to the school psychologist.
JG: I want to talk about solutions. You say: “Fundamental mental health reform is most likely to occur only once our political economy permits it—only once we have changed the economic approach and instituted more regulated, progressive, and socially democratic arrangements throughout our economy.” But I think many of your readers, armed with this new information, will want to know what they can do now to help themselves, or suffering loved ones, rather than wait patiently for a transformed economic system. Do you have any advice for them?
JD: Be healthily skeptical of traditional medicalizing services, which have led to an unjustified epidemic of psych-prescribing. Spend time searching for, where possible, more psycho-socially informed interventions and ways of thinking about your distress. There are multiple organizations and charities now offering more sociologically informed, relational, and non-pathologizing alternatives, but it will take some digging in the community to find them, as unfortunately such approaches have been grossly underfunded since the rise of medicalization.
JG: Thanks so much for taking the time to share your views. I certainly hope your book helps to bring about a far more socially and politically informed view of suffering.