‘Sedated’ may, at first glance, appear to be a book about the pharmaceutical industry, but it is much more than that – it is well reasoned and passionate attack on the way many of us live, particularly those of us in post-industrial western societies.
There has been a huge rise in anti-depressant use since the 1980s, particularly in countries that have espoused radical right of centre policies: privatisation, deregulation, low taxes, a tightening of government spending, the underfunding of public services.
In ‘Sedated’ James Davies makes a powerful and convincing argument that these policies have led to a mental health crisis. In 2020, for example, seven million people in the UK were using anti-depressants.
Inequality, deprivation, poverty, these, Davies asserts, are the main causes of the mental health epidemic. There is a correlation between marginalisation and poor mental health. So we should not look at the individual as the cause, but at economic and social structures. By blaming the individual and by promoting pharmaceuticals as the solution, we are, Davies writes, promoting ‘the medicalisation of distress’. And this medicalisation furthers the profits of the drug companies.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was, at one point, number one in Amazon books despite its cost: around $88. It’s a huge book listing 370 mental disorders, these created by a panel of psychiatrists, many linked with big pharmaceutical companies who, in turn, buy the book and distribute, free, to clinicians. These professionals, many overworked and doing what they can, prescribe the pharmaceutical company’s drugs, eg anti-depressants, anti-psychotics. It’s not a huge leap to imagine that some of the disorders have been included so that pharmaceutical companies can devise cures. But do the drugs work? Davies suggests many don’t. What works better, is therapy.
So, when, in 1998, the then Labour Government was presented with a case for using therapy as a cheaper alternative to medication, it did so without considering that for talking therapies to work, practitioners had to be given sufficient resources, and perhaps the most important resource was time. This initiative was not just a cynical means of saving money, there was good evidence to show therapy is more successful than medication at treating certain forms of mental illness. What emerged was IAPT (Improving Access to Psychological Therapies). And the story of what happened in IAPT is the narrative of many public services. The service is introduced with good intentions, but then, when the costs are examined, calls begin for more rigorous assessment and as these systems kick in, practitioners become overloaded, start gaming the system. James Davies compares what happened in IAPT to what has happened in the education system. And as an ex-headteacher, I know he is absolutely right.
The DSM, (see above), anti-depressants, and to some extent even IAPT, have at their core the suggestion that there is something wrong with the individual. What James Davies suggests is the problem is structural, woven into the way we lead our lives, particularly in countries, like the UK and the US, where people experience huge inequalities.
In the UK, for example, the richest fifth own 50% of the wealth, the lowest fifth only 4%.
Pfizer, who makes Sertraline, the biggest selling anti-depressant in the world, have a clear interest in maintaining this status quo.
For example, Pfizer funded the PHQ9 and GAD7 questionnaires, used by clinicians to diagnose depression and anxiety respectively. These questionnaires were devised by a team at Colmbia University with a grant from Pfizer. Pfizer produce, among other things, anti-depressants, including Sertraline, or Zoloft, the most commonly prescribed anti-depressant in the world. (18 million prescriptions in 2021).
The bar set in these questionnaires is very low, for example:
Over the last two weeks how often have you been bothered by any of the following problems:
– little interest or pleasure in doing things? Feeling down, depressed or hopeless?
– trouble falling or staying asleep or sleeping too much?
– feeling tired or having little energy?
If presented with such a questionnaire most of us, perhaps after a particularly bad week, might score highly. But would we want anti-depressants?
The drug companies fund the DSM, fund the questionnaires, and sell their drugs.
Davies writes this: ‘There is nothing scientifically valid or indeed clinically helpful in reclassifying understandable human suffering as mental pathology.’ And then he expands the probable causes of human suffering as marginalisation, disadvantage, abuse, neglect.
Davies asserts that medicalisation depoliticises depression, or its cause, suffering. He suggests the massive rise of anti-depressant use since the 1980s was triggered by radical conservative or neoliberal policies of Reagan and Thatcher – both influenced by the economist Milton Friedman, of economic freedom at the expense of social democracy, privatisation and personal wealth instead of funding of social support structures. It should be remembered that Friedman advised the dictator Pinochet after the military coup in Chile in 1973. Pinochet’s regime murdered hundreds, perhaps thousands of its own people. Despite this, Friedman called what happened there a ‘miracle’.
Neo-liberalism puts individual responsibility and freedom at the core of its belief. Low taxes, for example, at the expense of public services. The individual is responsible for his or her own destiny. Therefore when things go wrong, it isn’t economic conditions, it isn’t the lack of a support network, it’s the individual at fault. (Remember, it was Thatcher who said ‘there is no such thing as society.’) So, instead of challenging the system, we blame the individual, and prescribe them anti-depressants, even though there is growing evidence to suggest that the drugs don’t work.
There is a clear link between poverty and the prescribing of anti-depressants. Or, perhaps more subtly, it is a link between inequality and medication. Here Davies cites ‘The Spirit Level’, the 2009 book by Richard Wilkinson and Kate Pickett. The book asserts that in every major aspect of life, health, education, justice, individuals in societies with less inequality fare better. It’s an astonishing book, one that sits alongside ‘Sedated’ as a quietly measured, yet explosive demolition of radical right wing economics.