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Is Psychiatry the New ‘Opium of the People’?

Picture credits: Atlantic Books/James Davies/Neel Burton

Dr James Davis is a medical anthropologist and trained psychotherapist who is perhaps best known for his book of 2013: Cracked: Why Psychiatry Is Doing More Harm Than Good.

Cracked is a forensic examination of our increasing reliance on psychiatry and psychiatric drugs, in which Davis essentially argues that psychiatry ‘in the name of helping others, has actually been helping itself’.

His latest book, Sedated (March 2021), is broader in scope, looking at the social and political underpinnings that facilitated and enabled this state of affairs.

Since the early 1970s, the number of mental disorders listed in the DSM, the American classification of mental disorders, has risen from 106 to 370. Antidepressant prescribing in the U.K. surged from 25 million prescriptions per year in 2002 to nearly 75 million in 2020. The coronavirus pandemic has only accelerated the trend—while more benign and empowering psychological treatments are ever harder to access.

In Sedated, Davis puts it to us that psychiatric interventions, including superficial psychological interventions principally aimed at returning people to productivity, merely create the illusion of care while leaving the structural causes of distress intact. More than that, by shifting the blame or responsibility onto the sufferer, they serve to obscure these structural causes and, thereby, to preserve and entrench the neoliberal status quo.

The interventions favoured by the government, including even the psychological interventions, are those that involve internal rather than external change, because internal change promises to increase economic productivity and so cost-effectiveness, which is the preferred criterion for endorsing one treatment over another. If we are suffering, we are simply to stiffen ourselves to the social problems created by successive policies aimed solely at the bottom line.

Karl Marx famously said that ‘religion is the opium of the people’. The social institutions responsible for understanding and managing suffering are critical to the preservation of vested interests. With the waning of religion in the West, priests may have been supplanted by psychiatrists. The idea that a pill can make us happy ought to be inherently suspicious but fits perfectly with our materialistic and mechanistic worldview.

Thus, according to the prevailing narrative, suffering is rooted in individual rather than social or existential causes, while well-being is whatever best serves the economic imperative. Behaviours that disrupt economic activity are labelled as mental disorder, and this mental disorder presents yet another money-making opportunity.

If so many of us are ill, if a quarter of us are taking a psychiatric drug, this is because our suffering, having been stripped of its deeper purpose and meaning, is no longer being heeded. It is no longer being interpreted as a vital call to change, or to protest against harmful or inhibiting conditions. 

On the contrary, once we identify as mentally ill, we become disempowered in the belief that the problem lies solely with us, or, more precisely, with misfiring chemicals in our brains. While we are at the clinic, we are not at the barricades.

And while we work to grow the economy, we are not working to grow ourselves.

This is very big picture stuff from James Davies, who weaves our worst fears into a coherent, compelling, and damning narrative.

Neel Burton is author of The Meaning of Madness.

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Orson Welles tells reporters that no one connected with the broadcast had any idea that it would cause panic. (October 31, 1938). Source: Acme News Photos/Wikicommons (public domain)

On October 30, 1938, Orson Welles broadcast an episode of the radio drama Mercury Theatre on the Air. This episode, entitled The War of the Worlds and based on a novel by HG Wells, suggested to listeners that a Martian invasion was taking place. In the charged atmosphere of the days leading up to World War II, many people missed or ignored the opening credits and mistook the radio drama for a news broadcast. Panic ensued and people began to flee, with some even reporting flashes of light and a smell of poison gas. This panic, a form of mass hysteria, is one of the many forms that anxiety can take.

Mass hysteria can befall us at almost any time. In 1989, 150 children took part in a summer programme at a youth centre in Florida. Each day at noon, the children gathered in the dining hall to be served pre-packed lunches. One day, a girl complained that her sandwich did not taste right. She felt nauseated, went to the toilet, and returned saying that she had vomited. Almost immediately, other children began experiencing symptoms such as nausea, abdominal cramps, and tingling in the hands and feet. With that, the supervisor announced that the food may be poisoned and that the children should stop eating. Within 40 minutes, 63 children were sick and more than 25 had vomited.

The children were promptly dispatched to one of three hospitals, but every test performed on them was negative. Meal samples were analyzed but no bacteria or poisons could be found. Food processing and storage standards had been scrupulously maintained and no illness had been reported from any of the other 68 sites at which the pre-packed lunches had been served.

However, there had been in the group an atmosphere of tension, created by the release two days earlier of a newspaper article reporting on management and financial problems at the youth centre. The children had no doubt picked up on the staff’s anxiety, and this had made them particularly suggestible to the first girl’s complaints. Once the figure of authority had announced that the food may be poisoned, the situation simply spiralled out of control. 

Mass hysteria is relatively uncommon, but it does provide an alarming insight into the human mind and the ease with which it might be influenced and even manipulated. It also points to our propensity to somatize, that is, to convert anxiety and distress into more concrete physical symptoms. Somatization, which can be thought of as an ego defence, is an unconscious process, and people who somatize are, almost by definition, unaware of the psychological origins of their physical symptoms.

As I discuss in The Meaning of Madness, psychological stressors can lead to physical symptoms not only by somatization, which is a psychic process, but also by physical processes involving the nervous, endocrine, and immune systems. For example, one study found that the first 24 hours of bereavement are associated with a staggering 21-fold increased risk of heart attack. Since Robert Ader’s early experiments in the 1970s, the field of psychoneuroimmunology has blossomed, uncovering a large body of evidence that has gradually led to the mainstream recognition of the adverse effects of psychological stressors on health, recovery, and ageing, and, inversely, of the protective effects of positive emotions such as happiness, belonging, and a sense of purpose or meaning.

Here, again, modern science has barely caught up with the wisdom of the Ancients, who were well aware of the close relationship between psychological and physical well-being. In Plato’s Charmides, Socrates tells the young Charmides, who has been suffering from headaches, about a charm for headaches that he learnt from one of the mystical physicians to the King of Thrace. However, this great physician cautioned that it is best to cure the soul before curing the body, since health and happiness ultimately depend on the state of the soul: 

He said all things, both good and bad, in the body and in the whole man, originated in the soul and spread from there… One ought, then, to treat the soul first and foremost, if the head and the rest of the body were to be be well. He said the soul was treated with certain charms, my dear Charmides, and that these charms were beautiful words. As a result of such words self-control came into being in souls. When it came into being and was present in them, it was then easy to secure health both for the head and for the rest of the body. 

Mental health is not just mental health. It is also physical health.

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pink glassesThe Norwegian philosopher Peter Wessel Zapffe argued, essentially, that the human capacities for reason and self-awareness break with nature, giving us more than we, as a part of nature, can carry. So as not to go mad, ‘most people learn to save themselves by artificially limiting the content of consciousness.’

People not only limit the content of consciousness, but also fill it with less than the truth. In particular, most people think more highly of themselves than is warranted: they have an inflated sense of their qualities and abilities, an illusion of control over things that are mostly beyond them, and a misplaced optimism about their outcomes and prospects.

For example, most people claim to compare favourably to the average road user, citizen, parent… which is, of course, mathematically impossible, since not everyone can be above average. A couple on the verge of tying the knot is likely to overestimate the odds of having a carefree honeymoon or a gifted child, while underestimating the odds of having a miscarriage, falling ill, or getting divorced.

The concept of positive illusions first appeared in 1988, in a paper by Shelley Taylor and Jonathon Brown entitled, Illusion and well-being: A social psychological perspective on mental health. Still today, it is commonly believed that mental health corresponds to accurate perceptions of the self, the other, and the world, but in their paper Taylor and Brown argued that the evidence suggests otherwise, and that positive illusions are characteristic of normal human thought.

Positive illusions are helpful in so far as they enable us to take risks, invest in the future, and fend off despair and depression. After all, how many people would get married if they had any real sense of what awaited them? But in the longer term, the poor perspective and judgement that come from undue self-regard and false hope are likely to lead to disappointment and failure, to say nothing of the inhibitions and emotional disturbances (such as anger, anxiety, and so on) that can derive or descend from a defended position.

Positive illusions tend to be more common, and more marked, in the West. In East Asian cultures, for example, people are less vested in themselves and more vested in their community and society, and tend, if anything, to self-effacement rather than self-enhancement.

Positive illusions are also more prevalent in unskilled people, possibly because highly skilled people tend to assume, albeit falsely, that those around them enjoy similar levels of insight and competence. This Dunning-Kruger effect, as it has been called, is neatly encapsulated in a short fragment from the introduction to Darwin’s Descent of Man: ‘…ignorance more frequently begets confidence than does knowledge…’ And, of course, it may also be that, compared to highly skilled people, unskilled people are more reliant on positive illusions for their self-esteem and broader mental health.

Depressive realism

Just as it is commonly believed that mental health corresponds to accurate perceptions of the self, the other, and the world, so it is commonly believed that depression results in, or results from, distorted thinking.

‘Cognitive distortion’ is a concept from cognitive-behavioral therapy (CBT), developed by psychiatrist Aaron Beck in the 1960s and routinely used in the treatment of depression and other mental disorders. Cognitive distortion involves interpreting events and situations so that they conform to and reinforce our outlook or frame of mind, typically on the basis of very scant or partial evidence, or even no evidence at all.

Common cognitive distortions in depression include selective abstraction, personalization, and catastrophic thinking:

  • Selective abstraction is to focus on a single negative event or condition to the exclusion of other, more positive ones, for example, ‘My partner didn’t call me yesterday. He must hate me.’
  • Personalization is to relate independent events to oneself, for example, ‘The nurse is leaving her job because she’s fed up with me…’
  • Catastrophic thinking is to exaggerate the negative consequences of an event or situation, for example: ‘The pain in my knee is only going to get worse. When I’m reduced to a wheelchair, I won’t be able to go to work and pay the mortgage. So I’ll end up losing my house and dying in the street.’

However, the scientific literature suggests that, despite their propensity for such cognitive distortions, many people with depressed mood can also have more accurate judgement about the outcome of so-called contingent events (events that may or may not occur) and a more realistic perception of their role, abilities, and limitations—a phenomenon that is sometimes, and controversially, referred to as ‘depressive realism’.

The concept of depressive realism originated in 1979, in a paper entitled Judgment of contingency in depressed and nondepressed students: sadder but wiser? On the basis of their findings, the authors, Lauren Alloy and Lyn Abramson, argued that people with depression make more realistic inferences than ‘normal’ people, who are handicapped by their positive illusions. On the face of it, this suggests that people with depression are able to see the world more clearly for what it is, while normal people are only normal in so far as they are deceiving or deluding themselves.

This is a seductive proposition for someone like me, who has long been arguing that depression can be good for us—for example, in my book, The Meaning of Madness. But here’s the rub: people with depression are pessimistic even in situations in which pessimism is unwarranted, suggesting that, rather than being more realistic, their thinking is merely ‘differently biased’, and just as rigid and distorted as that of normal people with their positive illusions.

Wisdom, it seems, consists in being able to shed our positive illusions without also succumbing to depression, although, for many, depression may be a necessary step along the way.