While general medicine has certainly advanced over the last few decades, clinical psychology has travelled a deeply distressing trajectory. As Marx thought of religion, the role of the mental health sector is now to sedate, to distract from distress and to prevent political action, all in the interests of our neo-liberal economy. Following the publication of his book, Sedated, How Modern Capitalism Created our Mental Health Crisis, James Davies explains.
Since the 1980s, clinical outcomes in general medicine have been on a positive trajectory upward, due to impressive advancements in biomedical research, technology and treatment. While progress has been rapid throughout general medicine, one area of health care has nevertheless bucked the trend – the area of psychiatry and mental health.
Not only have clinical outcomes broadly flat-lined in this area, but according to some measures they have declined. In recent decades, mental health disability rates have almost trebled; the prevalence of mental health problems has risen fourfold, while for people diagnosed with serious mental health issues the gap between their life expectancy and everyone else’s has widened (from 10 years to 20). These and other dire statistics exist despite our having invested over quarter a trillion pounds in UK over quarter a trillion pounds in UK mental health research and services since the 1980s, and despite nearly a quarter of our adult population receiving some kind of mental health intervention each year.
To understand what has gone wrong I want to first take a seemingly unconventional route, by invoking an idea that the political economist, Karl Marx, once used to explain the impact that organised religion exerted upon a health crisis of his own day – one caused by wide economic exploitation.
Marx argued that religion, by teaching that our suffering in this life would be rewarded in the next, was instructing people, and usually the most disadvantaged people, to accept and endure rather than to fight and reform the harmful social realities oppressing them. As religion numbed the distress that would otherwise motivate political action, he referred to it as ‘the opium of the people’ – a cultural sedative powerful enough to disable the impulse for social reform.
While progress has been rapid throughout general medicine, one area of health care has nevertheless bucked the trend – the area of psychiatry and mental health.
What Marx articulated through his analysis of religion was that those social institutions responsible for understanding and managing suffering were critically important to the aims of any economy. By adapting to the needs of the wider economic system, these institutions had the power to defuse politically dangerous emotions that could otherwise disrupt the economic interests of the established order.
While Marx’s argument targeted religion during industrial capitalism, its analytical thrust over the 20th century would influence social scientists across the political spectrum. They would use his ideas to explain how social institutions (e.g. religion, education, health care) all adapted to the aims of the wider economy, mostly to ensure their own survival and success. In what follows, I want to explore how this enduring idea can help explain the failure of our mental health sector to improve its outcomes since the 1980s.
As a starter, it is important to acknowledge that the mental health sector, when compared to other social institutions, has been exceedingly responsive to the economic currents of our time. Unlike our legal system, where practice is rooted in long-standing legislative anchors, or our medical system, where practice revolves around the bedrock of biological fact, the foundations of our mental health sector are relatively capricious. The sector has found almost no biological markers to anchor its treatment of mental distress, while its theories and practices are mostly rooted in the preferences of those who have the money and power to shape the evidence-base. Our mental health sector, a bit like our education sector, then, has had little protection against what more powerful politico/economic interests have demanded of it. The result has been the sector’s growing servitude to its spontaneous adaptation to the economic dictates of the last 30 years.
Our mental health sector has had little protection against what more powerful politico/economic interests have demanded.
To understand this dynamic, let’s look at the ways in which our mental health sector has broadly adapted to the needs of our economy, but at the expense of generating the good clinical outcomes we all want and deserve. There have been four main trends.
The first, and perhaps the most significant, is the trend of over-medicalisation. Since the 1980s, under the control of the psychiatric profession, the sector has progressively renamed more and more of our natural and normal (albeit painful) human responses to the difficulties of living as ‘mental disorders’ requiring medical intervention. It has achieved this by inflating the number of mental disorders believed to exist (from 106 in the early 1970s to around 370 today) and by progressively lowering the bar for what constitutes having a psychiatric disorder (making it easier for any of us to be classed as ‘mentally ill’).
By expanding the definition of mental illness to encompass ever more domains of human experience, the sector has not only reconfigured how we respond to distress in health care settings, but to how we respond to distress in the wider world: grief at a significant loss, struggling to reach orgasm, experiencing lack of concentration at school, undergoing trauma, feeling anxious about public events or simply underperforming at work are just some of the manifold painful human experiences now liable to psychiatric framing and intervention.