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Human beings are living longer and better lives. Medicine has succeeded in erasing diseases from the face of the Earth, greatly reducing the severity of others and treat many who were once incurable. Most of these advances were made in the second part of the 20th century. But there is still one field that has not improved in the last 50 years and, in fact, things are getting worse: mental health. More and more people are suffering from conditions in this field and the drugs used to treat them have not advanced for decades.
Research has shown that most antidepressants are better than placebo for only a small proportion of patients with the most severe illnesses. At the same time, more and more people are consuming all kinds of psychotropic drugs for longer than is recommended, something that can worsen mental illnesses, in addition to causing other health-related problems.
James Davies, reader in medical anthropology and psychology at the University of Roehampton in London, has just published a Spanish edition of his 2021 book Sedated: How Modern Capitalism Created Our Mental Health Crisis. In it, he makes a prophetic review of this reality, pointing out factors that he believes are key: the medicalization of problems; the system’s obsession with creating productive consumers, instead of making people happy; and an approach to mental health that seeks to alleviate symptoms rather than address the source of the conflict, which is often related to precarious jobs, low wages and lack of free time. The native Londoner, who chose not to provide his age, spoke with EL PAÍS by videoconference.
Ask. One of the main theses of the book is that the problem of mental health in the West does not come from biological causes, but from material ones. Are people’s work situations the main cause of mental health problems?
Reply. There are a host of different issues that can lead large sections of the population to manifest what are reframed as symptoms of mental health disorders. In fact, working life is just one of them. And that obviously depends on the particular working conditions you are subjected to. But what we have seen in the contemporary West, since the 1980s, are rising levels of worker dissatisfaction and disengagement. And these levels of distress are obviously rooted in the structural determinants of our modern work economy. But the most unsatisfying jobs in our labor economy tend to be jobs located in the service sector. And indeed, this is the sector that has been expanding rapidly since the 1980s.
We have also seen a whole set, which I described in the book, of employment policies that have made working life less tolerable for more and more people. The elimination of unionized labor protections, the increased need for dual-work households, we’ve seen flat wages, we’ve seen an increase in precariousness and short-termism within the labor market… We stay for much less time at any given time. occupation than 30 years ago, which disrupts our ability to build sustainable social relationships. But what we’re doing is instead of embracing and trying to identify and reshape some of the structural drivers of distress and dissatisfaction, we’re beginning to reframe that dissatisfaction as some kind of medical problem, the solution of which lies in medical interventions, in rather than social intervention.
what Does our society resemble the one portrayed by Aldous Huxley in brave new world?
A. Huxley is obviously talking about the extent to which, as a society, we are being chemically driven. I think when we look at the numbers, it’s pretty clear that we really are at a point where his prophecy, if you will, has almost come true. In the UK, about 25% of the adult population were prescribed some kind of psychiatric drug in the past year. This is a quarter, with numbers increasing by about 7% each year. So we are not going to see a change in this trend anytime soon. And that’s not just the case in the UK. That is the case in the US, in Spain, in most Western economies, where psychotropics are widely used. And in the book, he argues that this increasing medicalization and medication of our emotional lives essentially distracts us from some of the more structural and systemic problems driving high levels of distress in contemporary society.
As far as Keynes is concerned, by 2020 we would be in a situation where we would only be working an average of 15 hours a week.
what Do you think that a reduction in working hours or a reduction to four days of work a week would result in better mental health?
A. Okay, yes. In the book, I am referring to the now famous article by [John Maynard] Keynes, where he seeks to predict what the economy might look like now, in the 2020s, if Keynesian principles are allowed to come to fruition over a 60-year period. And as far as he’s concerned, we’re going to be in a situation where we’re only working an average of 15 hours a week. And this was, to him, a very desirable state of affairs, because what it would mean is that we could spend the rest of our time in what he loosely calls cultivated leisure: the activity of cultivating self, cultivating relationships, building our communities, creating a world that was facilitative, and that was good for the soul. And that should be the main occupation of life. So, I think to the extent that we spend the time we have available reducing the working day on useful and meaningful activities, absolutely. This would be a boon to our entire mental health. One of the interesting things about the first pandemic lockdown was that there was a lot of coverage about how the pandemic exacerbated poor mental health. But what was much less commonly reported was the extent to which the first lockdown in particular improved the mental health of a large part of the population, with about a third of people reporting that they actually felt better as a result of the lockdown than before. And just 7% of people in the UK reported wanting life to return to normal after lockdown. And the reason, over and over, cited as to why people felt a boost in wellness and why they didn’t want to go back to normal after the pandemic was because of work.
what You focus on the social causes of mental health problems. But aren’t there biological and genetic causes for these problems?
A. Well, for the vast majority of mental health conditions, no biological markers have been found. That is why we do not have biological tests to verify any type of psychiatric diagnosis. So in the absence of that, I think it’s very problematic to assume that these are problems with biological roots. There is no evidence to support that. And, in fact, when we look at the interventions that we offer to patients, they seem to prefer the most social and psychological interventions to biological ones.
We have not seen an increase in the effectiveness of psychiatric medications.
what It doesn’t seem like psychiatry has been helping people very much, if you look at the overall results. As a psychiatrist, are you frustrated by that?
A. Yes absolutely. I think the most damning criticism of our mental health industry stems from looking at its clinical results. So, in almost every area of general medicine, we’ve seen an increase in results since the 1980s. In general, that’s what we’ve seen. And we have seen that in all areas of medicine except one, the area in which I work: the area of mental health, the area of psychiatry. In that area since the 1980s, clinical outcomes have not only generally stagnated over that time period, but by some measures have actually worsened. Therefore, the prevalence of mental health problems has quadrupled during that time period. We’ve seen mental health disability rates triple during that period and, more worryingly, where psychiatric drugs are prescribed more aggressively, we’re seeing the gap between their life expectancy and that of all others is extended from approximately 10 to 20 years during that period. time frame. Also, we haven’t seen an increase in the effectiveness of psychiatric drugs over that period of time, according to research, and there are these appalling statistics, even though we’ve spent in the UK at least around a quarter of a billion pounds [$327 billion] on mental health services and research since the 1980s. I would argue that the situation is so serious because essentially we have taken the wrong approach: the overmedicalize and medicate approach, which does not take into account the social and psychological drivers that are lie behind the difficulties of most people.
what What is the role that you think psychiatrists should have?
A. I think there is a role for psychiatric medication. I think we know from research that the most severely distressed members of society may benefit from certain types of short-term medication in particular. So there is a role for doctors in that sense, there is a role for psychiatrists in determining whether or not the problems that a person is going through are related to some other medical problem that they may have. Physicians are uniquely equipped to do such investigative work. So there is a role for psychiatric medications, and they would be provided by doctors. But I would say that it is a very reduced one and much more regulated than the one we have today.
what Should general practitioners be able to prescribe antidepressants, for example?
A. I think we need much stricter regulation of prescribing in primary care. We’re seeing large percentages of these drugs being prescribed to people who really shouldn’t be taking them, who fall into the mild and moderate depression categories. The only area where we see any benefit beyond placebo is in patients with more severe, very severe, distress. But this is not the majority of people who come to primary care and receive antidepressant treatment through primary care. I think one of the reasons we’re seeing high levels of prescribing in primary care is because there’s simply a lack of alternatives. Doctors instinctively want to help the patient. They are suffering and feel morally obligated to do something. And when there are no alternatives, what usually happens by default is that a good depressant is prescribed, even if the doctor has reservations about it.
