The medicalisation and commodification of distress
I am feeling tragically vindicated in my growing concerns about current social attitudes to mental health after reading the recently published book by James Davies, Sedated: how modern capitalism created a mental health crisis.
Davies argues that, since the 1980s, successive governments and big businesses have worked to promote a new vision of mental health; one that puts at its centre a new kind of person - resilient, optimistic, individualistic and, above all, economically productive. The kind of person the new economy needs and wants.
Davies contends that, as a result of this shift, our internal approach to mental health has radically altered to meet these market demands. We define a return to health as a return to work. We blame suffering on faulty minds and brains rather than on harmful social, political and work environments.
We promote highly profitable drug interventions, which, if great news for big pharmaceutical corporations are, in the long-term, holding billions of people back. Davies believes that this marketised vision of mental health has stripped our suffering of its deeper meaning and purpose and that, consequently, our distress is no longer seen as a vital call to change, or as anything potentially transformative or instructive.
I strongly agree with this perception, and my ongoing PhD narrative inquiry with older counselling service users is beginning to provide indications that support the alarming conclusions of Davies powerful, thought-provoking and timely book.
Davies argues convincingly, drawing on international research evidence that mental health, instead of being a concerning social and political issue has rather become, over the last few decades, an occasion for yet more buying and selling. Whole industries have thrived on the basis of this logic, offering self-interested explanations and solutions for the many panes of living.
The cosmetic industry locates our misery in our ageing, the diet industry in our bodily imperfections, the fashion industry in our being passé, and the pharmaceutical industry in our so-called faulty brain chemicals.
While each industry offers its own profitable elixir for emotional success, they all share and promote the same consumerism philosophy of suffering: our central problem is not that we've been mistaught how to understand and engage with our difficulties (our ageing, our trauma, our sadness, our anxiety or grief), but the fact that our experiences of suffering are all something that targeted consumption can address.
Suffering is the new bad and failing to consume the right remedies is the new injustice.
This pro-market agenda has begun to harm both the UK and the West in general, turning our entire approach to mental health into something preoccupied with sedating us, de-politicising our discontent and keeping us productive and subservient to the economic status quo.
By putting economic servitude before real individual health and flourishing, our priorities have become dramatically and dangerously misplaced, and more suffering, paradoxically, has been the unhappy result.
Through my research, I am trying to do my part in helping to correct this dominant yet misguided approach and to discuss how we might put things right by understanding and solving the real roots of our mental and emotional distress through a more multidisciplinary and existential approach.
According to Davies, we are rapidly becoming a nation sedated by mental health interventions that greatly overplay the help they bring; that subtly teaches us to accept and endure, rather than to stand up and challenge, the social and relational conditions harming us and holding us back.
Like Davies, in my research, I argue that the wider social and economic climate of late capitalism has allowed this highly medicalised, marketised and deeply political way of managing our emotional distress to flourish unimpeded, despite its clear failings on a whole host of the most important research metrics.
According to the NHS' own independent mental health task force, mental health outcomes have actually worsened in recent years, as have rates of suicide. In the UK the mortality of those suffering from severe and sustained emotional distress is now 3.6 times higher than in the general population, with people so diagnosed dying approximately 20 years earlier than the average person.
Whilst it is true that some people report feeling validated by receiving a psychiatric diagnosis, building their identity around it, research shows that having our emotional distress re-framed as a mental disorder, illness or dysfunction (which incidentally is now a precondition for accessing NHS psychological support services in the UK), may adversely impact on our recovery.
This is especially true if people are led to believe that their problems are rooted in biological abnormalities, which calling these problems medical or mental illness actually encourages. For example, according to recent research people who come to believe their problems are due to chemical imbalances experience worse pessimism about their recovery, increased self-stigma, bought negative expectations and self-blame, and as well as more depressive symptoms after the close of their treatment, compared to people who reject this hypothesis.
Similar results have been found for those who embrace biogenic explanations for their distress, which regularly increases stigmatising attitudes among patients and mental health professionals as well as hopelessness in those believing their conditions to be chronic (i.e. lifelong).
One of the probable reasons why medicalised distress can cause such harm is that once people identify with being mentally ill, it may become harder for them to think of themselves as healthy participants in normal life, or as being in control of their own fate.
They now have a psychiatric illness that sets them apart and rendered them dependent long-term on psychiatric authority. As a result, they are subtly requested to rethink, or even downgrade, their prospects and ambitions for the future, as well as to relinquish part of their agency.
Whilst all this can exacerbate self-stigma, self-blame and pessimism for many people, being medicalised also negatively influences how others treat to perceive those who have been diagnosed. We know from research, for example, that framing emotional problems in terms of an illness or disorder is more likely to kindle fear, suspicion and hostility in other people than if we articulate those very same problems in non-medical, psychological terms.
Davies draws on substantial social science research which suggests that similar forms of stigma even exist when people are ascribed the least stigmatised label, such as depression, for example, recipients so labelled as still more likely than non-recipients to be viewed by others as having frail will or character flaws, as being afflicted by personal weakness, or us being lazy and unpredictable.
When people are ascribed with more serious labels, like schizophrenia, they are more likely to be perceived as highly unpredictable and potentially dangerous, which can compound their sense of isolation through social rejection.
Research has shown in fact that even when people are given false diagnoses by researchers, members of the public will still stigmatise the behaviour of these patients, despite such patients behaving completely normally. The labels, in other words, have powerful cultural effects that shape public perceptions of those being diagnosed, even if these negative perceptions bear no relation to the person at all.
It is perhaps for these reasons that the largest ever meta-study into how medicalisation impacts outcomes, cited by Davies, simply concluded that medicalisation is no cure for stigma and may create barriers to recovery. If we want to reduce stigma in its various forms, the research implied, we should start by reducing the dominance of medicalisation that drives it up (Davies, 2021).
Understanding human suffering
Compared to even 20 years ago, public conversations around mental health have hugely proliferated. We are perhaps more able and willing than ever before to open up about our private woes. This, of course, is a good thing. But it is clearly insufficient in making things better.
What matters more is how a person's actual distress is understood and managed once it has been courageously disclosed, and whether this is done in humane and effective ways.
With respect to honouring this part of the deal, we certainly have a very long way to go, according to Davies' conclusions, and also as initially indicated in my ongoing counselling research. Despite the various ways in which we are told 'it's good to talk', the responses awaiting most people when they do tend to be fairly homogenous and predictable.
Whether we encounter these messages at school, at work, at home or on social media, most are still laden with an underpinning medicalised philosophy that subtly pathologises us and, thus, depoliticises us and disempowers our feelings of distress in adversity.
Now, in the post-Covid world, where we are all being asked to open up even more readily, the effects of this are only set to spread further, as rising distress is re-framed as rising mental illness, and the psychiatric prescriptions further proliferate in response.
Given this individualistic and medicalised cultures continued expansion, vividly documented by Davies and echoed by many other influential dissenting voices, it is absolutely vital that we question why it thrives year on year despite its presiding over the very worst outcomes in our health sector.
To answer this, according to Davies, we must move beyond the expansive power and ambition of 'Big Pharma' and the mental health professions themselves. We are invited by Davies to look at the wider political and economic arrangements that have enabled a particular ideology of suffering to dominate our lives in the last 30 years. Only by doing this will be able to glimpse the various hidden mechanisms that keep our failing system operational at considerable human and economic expense (Davies, 2021).
One of the broader aims of my ongoing psychotherapy research is to shed light on the alarming social phenomenon of the increasing medicalisation of suffering and distress. I am listening to and analysing the later life stories and perceptions of counselling service users, aged 65 upwards, who have described and constructed the experiences, thoughts and feelings they brought them to talking therapy. They have told their personal tales of adversity in their own terms, and in the context of their own unique lives and worldviews.
James Davies' timely post-pandemic publication has inspired me to continue working harder on my PhD counselling research at Warwick University Centre for Lifelong Learning. Thanks to his powerfully argued book, I now have a greater sense of urgency and justification for my ongoing project. His wise perceptions have re-kindled the continuing sparks of passion for human rights and social justice which still motivate me.
At the growing and developing, not disintegrating and declining, age of 72, I am still striving to make a difference. I genuinely regard my own occasional periods of melancholy and despair as a completely rational response to an absurd world. Therefore, I optimistically believe that my decision to do a practitioner research PhD as a working psychotherapist in my own later life is a worthwhile social reform enterprise.
More about my ongoing narrative inquiry can be found in my counselling directory article, Existential Therapy and Lifelong Learning. I have also written about my developing person-centred approach to psychological support during the coronavirus pandemic in my article, Coping with Coronavirus through existential therapy.