Sedated: How Modern Capitalism Created Our Mental Health Crisis

James Davies

Atlantic Books, £18.99

Review by Jamie Maxwell

Since the 1970s, the number of mental health disorders formally recognised by Western medical science has jumped from 106 to more than 370, the academic and psychotherapist James Davies notes in the opening pages of Sedated. The use of antipsychotic drugs to treat “sustained emotional distress” has climbed over that period, too. In 1988, roughly 2% of American adults consumed some form of mood-altering or mood-enhancing medication. By 2017, that figure was 12.7%. In Britain, the rise of anti-depressants has run parallel to the expansion of cheap credit and the Thatcherite unravelling of economic regulation: as the country’s stockpile of private debt has grown, so has its dependency on pharmaceuticals. 

In his first book, Cracked (2013), Davies exposed the rampant profiteering of the drugs industry and the corrosive effects of mass-marketed prescriptions. In Sedated, he advances a similar argument but within a broader thematic remit. Ordinary human suffering has been medicalised and commodified by the free market, Davies says. Capitalism’s emphasis on individual responsibility keeps us locked in a state of existential unrest. Contrary to popular understanding, depression isn’t a biological condition triggered by “misfiring chemicals” in the brain; it is a rational response to material factors – grief, poverty, unemployment, isolation – that lie beyond our immediate control.

The answer to Anglo-America’s intensifying mental health crisis, according to Davies, is radical political reform. Late neoliberal norms – long working hours, low pay, insecure employment – should be ditched in favour of policies that tackle the “social roots” of despair: higher taxes on the rich, a more generous welfare system, stronger workplace rights, and a national health service capable of delivering comprehensive therapeutic care. The Covid pandemic has made structural change possible in a way it wasn’t 16 months ago. Coronavirus has highlighted the “gaping economic inequalities” at the heart of British and American life, Davies believes; the civic costs of unfettered capital, meanwhile, have never been more apparent. 

Davies’s premise is controversial: if everyone in the medical profession shared his hostility towards antipsychotic drugs, doctors, presumably, would not routinely prescribe them. Sedated is nonetheless an intelligent and powerfully argued book.

Davies writes more as a memoirist than an academic, drawing on his first-hand experiences of the UK mental health system and his own apparent radicalisation in the wake of the 2008 financial crash. He interviews two senior Conservative politicians – former Chancellor Nigel Lawson and the recently ennobled Telegraph journalist Charles Moore – about the impact of free-market politics on Britain’s psychological health. Moore concedes that Thatcherism was excessively materialistic and that Margaret Thatcher herself was far too dismissive of the role played by social class in determining an individual’s life chances. The right’s “neo-managerial” desire to embed laissez-faire principles into every aspect of public life has shredded the collective ties that bound Britain together in the post-war period, Davies concludes. Little wonder, then, that growing numbers of people feel alienated from the institutions that govern them and seek to mask that alienation, however counterproductively, with anti-depressants.

Davies is at his best when critiquing pharmaceuticals as the solution to, or cure for, persistent feelings of anxiety and inertia. Over the past 50 years, huge advances have been made in the treatment of almost every kind of physical illness, from cancer to HIV. Few such advances have been made in the realm of psychiatry, however. In Britain and the US, diagnosed rates of depression have been on a steady upward trend for decades, despite the ever-growing prevalence of anti-depressants. There is even evidence that chemical medication can raise a patient’s risk of suicide, prolong their depression, and “erode the pre-frontal cortex”, resulting in long-term cognitive damage.

Davies sees depression as a central, even inescapable, feature of the human experience: misery, he insists, shouldn’t be categorised as a sickness, like dementia or diabetes, in need of urgent medical intervention. The moment we start thinking of ourselves as ill, as opposed to merely unhappy, we begin drifting into cycles of pessimism and dependency that are not easily broken. “Research shows that having our emotional distress reframed as mental ‘disorder’ may adversely impact our recovery,” he writes. “This is especially true if people are led to believe that their problems are rooted in biological abnormalities.”

Some of Davies’s observations sound fatuous next to the rigour of his wider psychiatric analysis. Much like Michelle Obama during the darkest days of the Trump presidency – which dragged the former first lady, by her own admission, into a bout of “low-grade depression” – we can transcend our current culture of fatalism and disengagement through direct political advocacy: “Her pain was her motivation; her action her therapy,” he writes. But as anyone who has ever been involved in grassroots politics knows, activism is a gruelling enterprise that almost always ends in failure. Davies also occasionally lapses into the same insipid language of self-help boosterism that he spends much of the rest of the book excoriating. “Suffering is the precondition for positive change,” he remarks at one point; “Life becomes more fulfilling not by having more stuff, but by living more authentically,” he intones at another. 

Still, a rich seam of empathy runs through Davies’s narrative. Sedated identifies one of the defining tensions of modern life: there is greater awareness than ever around issues related to mental health, yet mainstream psychiatric techniques haven’t improved in over half a century. Davies’s verdict on pharmaceuticals is damning: the relentless over-prescription of anti-depressants can’t and won’t solve problems that are profoundly social in origin. What we need to do, instead, is confront the pathologies of an economic model gone badly wrong.