Take the Tablets (2023)

Book Review from the August 2023 issue of the Socialist Standard

Sedated: How Modern Capitalism Created Our Mental Health Crisis. By James Davies. Atlantic £10.99.

The basic argument here is that the treatment of mental illness has been medicalised and depoliticised, meaning it has come to be regarded as a problem involving the individual concerned, rather than being part of a wider social situation. Consequently it has been addressed via increased prescription of medication, not by means of talking therapy or sociopolitical changes. This is to some degree due to the lobbying and influence of the pharmaceutical industry (drugs companies such as Pfizer). They aggressively advertise their products and even develop the patient questionnaires that GPs use to diagnose depression.

More generally, though, Davies sees it as part of a wider societal development, that of ‘new capitalism’, neoliberalism, based on deregulation of companies and a regulatory system that is closely linked to those it is allegedly controlling. Depression and anxiety supposedly cost the UK economy £12bn each year in lost productivity and incapacity benefits; this figure is from 2005, so the amount is presumably higher now. Reforming the benefit system and getting people into work was seen as vital, hence workfare and sanctions on the unemployed. Not having a job was regarded as some kind of psychological deficit, rather than being related to the ups and downs of the capitalist economy, just as problems at work were viewed as resulting from individual attitudes and difficulties, not the boring and often pointless nature of the job. The Labour government introduced a programme named Improving Access to Psychological Therapies (IAPT), but this had far less impact than claimed, with at most one person in five recovering as a result of it. In 2015 it was announced that IAPT workers would be placed in job centres.

There has been a vast increase in recent years in the prescription of antidepressants. This applies in many countries, including the UK, where the number rose from 25 million prescriptions a year in 2002 to 75 million in 2020. This has not led to an improvement in people’s mental health: far from it, as mental health disabilities have risen massively since the 1980s. When taken over the long term, many psychiatric drugs can be harmful, and it can in fact be more helpful to stop taking the drugs, even for the severely ill. Some research suggests that long-term antidepressant use can increase the risk of a person becoming depressed for life. A recent report (BBC Online, 19 June) revealed that in England two million people have been taking antidepressants for five years, despite limited evidence that a course of treatment of that length has overall benefits.

Davies notes that higher rates of prescribing psychiatric drugs occur in the poorest areas of the UK, and refers to the work of Wilkinson and Pickett (The Spirit Level, The Inner Level), which shows that there is more mental illness where there is greater inequality. He presents a powerful and convincing picture of how capitalism defines and treats mental health problems, meaning it avoids having to confront the real causes.

Paul Bennett

Blogger's Notes:

• Richard Wilkinson and Kate Pickett's The Spirit Level was reviewed in the June 2009 issue of the Socialist Standard.
• Richard Wilkinson and Kate Pickett's The Inner Level was reviewed in the October 2019 issue of the Socialist Standard.