Sedated
Sedated: How Modern Capitalism Created our Mental Health Crisis is a book by James Davies discussing the rise in use of psychiatric diagnosis and antidepressant prescribing.
Davies charts the rise of the DSM, Diagnostic and Statistical Manual of Mental Disorders, which is the standard textbook for psychiatric diagnosis. Now on the revision of its fifth edition, the DSM has massively expanded over the decades to include ever more labels. These labels have no biological basis and are generally the consensus of small committees many of whom have financial links to the pharmaceutical industry.
The author then goes on to connect this to the rise of neoliberalism. As Thatcher dismantled trade unions, increased inequality and reduced working-class people’s quality of life, something was needed to explain this suffering that depoliticised and managed that suffering. The answer was labelling people as mentally ill.
Today, if you are sad because your zero-hours contract means you both have a job and still need to rely on food banks, it is not because of inequality it is because you have an anxiety disorder, or a depressive disorder. It is you, the individual, that is broken, and not that you are living in an unfair society, or so the biomedical model of mental illness would have us believe. And wouldn’t you know it, uber-capitalism can sell us the solution in the form of some antidepressants or a course of CBT.
Some people do find labels helpful. But currently, this is the only lens we are using. And often, the only solution is antidepressants, or if you are lucky some non-trauma-informed CBT.
Thus, mental health has been redefined to conform to the needs of uber-capitalism. Someone who is “mentally well” is someone who can work. IAPT was explicitly set up with the idea of getting people back to work. And programmes like mental health at work initiatives or Mental Health First Aid try to teach us that we should find new ways to handle the suffering caused by low wages, lack of job security and 24/7 work stress.
Work can be meaningful and promote self-esteem. But many jobs today do not provide any dignity. 10% of nurses are using food banks. People are being forced into the gig economy never sure if they will get a pay cheque. People work in warehouses that are gutting their local high street while their bathroom breaks are timed.
Crucially, everybody suffers. Even those with well-paid jobs find themselves lacking meaning and social connectedness. So we try to fix it by buying more stuff. This creates a cycle of consumerism, and then having to invest in security systems and increased policing to protect our stuff, and that in turn divides communities further.
So, what do we do about all of this?
First, we need a model of mental health that targets the root causes: inequality and social isolation. Putting more money into training counsellors will not help because individual distress is a symptom of wider social problems and not something that can be fixed in itself.
Second, we need a wellbeing economy. We need a form of capitalism that works for the benefits of individuals, not for the benefit of capitalism itself. A good start would be undoing the harms of deregulation and rebuilding trade unions to move away from uber-capitalism to more balanced social democracy. This is the exact model that operates in Nordic countries who have the highest quality of life.
