You need to read this book (I realise I am late to the party on this). “Sedated” is not the first work (e.g. Empire of Pain) to raise awareness of these issues but it is the most succinct and well-balanced argument yet. The content of the finely-tuned polemic will irritate then enrage you at the state of UK mental health care provision – maybe even mobilise you. I am certainly questioning some of the underlying assumptions of my own mental health pathway.
In pain not pathological
The entire approach to mental health is preoccupied with sedating us, depoliticising our discontent and keeping us productive and subservient to the economic status quo
The book challenges the widely-popularised and strongly held belief that mental illnesses are caused by chemical imbalances in the brain that can be “managed” with medication. Instead, this perspective has been largely driven by the interests of the pharmaceutical industry.
Indeed, there is ongoing work showing how little serotonin actually plays in depression – throwing into question the efficacy and purpose of SSRIs, a type of widely prescribed antidepressant. More pertinent is the need to switch the narrative from “you are broken, take this to stay normal in perpetuity” to “you are in a terrible environment, let’s work together to get through this”.
What had the greatest impact on me was his continuing assertion from research and his medical practice that most people who present with “mental health issues”, are just experiencing suffering from a negative environment or situation. They don’t actually present a pathology of illness at all.
The idea that there is a ‘right’ or ‘wrong’ way to treat mental illness is a false dichotomy that overlooks the complexity and diversity of human experience.
Sedated medicalisation
The book provides an easy to comprehend and detailed history of the development of psychiatric medications, and the ways in which the industry has influenced the way mental health is understood and treated. It also explores the potential harms of over-reliance on medication including short-term side effects, as well as the preponderance of medications not actually being effective in the longer term.
Crucially, marketing of mental health since the 1980s has tended to blame faulty minds and brains rather than harmful social, political, and work environments. He also discusses the impact of a rise of target culture and New Managerialism in health and education, as the new Labour government built on the Thatcherite market reforms to change the governance of public sector institutions.
As a leading critic of the medicalisation of mental health, Davies argues that the increasing use of psychotropic medication has not led to improved outcomes for those with mental health conditions. Instead, he suggests that the industry has created a narrative around chemical imbalances to sell drugs and that this approach has become the dominant paradigm for treating mental illness.
The myth of the chemical imbalance has been perpetuated by psychiatry and the pharmaceutical industry for decades, and it has led to the overprescription of medication and the medicalisation of mental distress.
Public/private capture
Davies and I both share the view of the “capture” of the concept of resilience (pg 176-9) by the current status quo i.e. you need to be able and willing to deal with life. Any issues or problems are symptoms of an inner issue that you are in control of, not that the socio-macro-political-economic context of existence is actually what the problem is.
Whilst I did not care for the travelogue-style framing for most chapters, it does challenge its readers to think critically about the dominant paradigm of psychiatric medication, and encourages a more holistic and personalised approach to mental health.
Davies does an excellent job of presenting a wide range of evidence and perspectives to support his argument. He draws on historical and sociological research, as well as interviews with experts in the field, to explore the ways in which the pharmaceutical industry has influenced the way we understand and treat mental illness.
Sedated conclusion
The fact that mental health problems are deeply intertwined with social and environmental factors has been lost in our current narrow focus on the individual and their biology.
Davies takes us on a tour de force of content and context. We look at schools, workplaces with Mental Health First Aiders, civil service and New Labour New Managerialism, unemployment centers, and universal credit. As the book was released we were in the middle of 2021. The paperback release allows a small amount of detachment as we live in our post-COVID world. The themes identified on the lack of fundamental job satisfaction are playing out in more detail with the Great Resignation, a logical next step of the storyline of the book.
Davies rightly, if slightly disappointingly, points out that real change in this space will only come with real change in the political economy of neo-liberal societies. There is a need for growth in continual grassroots support and understanding from local GPs to the foundations of modern psychiatry. Nonetheless, we have to keep these ideas around. We have to keep them going so when there is a major change they will be ready, already rich and thought through to step into the gap.