Take your medicine: prescriptions for antidepressants have seen a threefold increase in the past 20 years. Photo: © Arno Massee / Alamy Stock Photo

Pills, bills and heartache: how Big Pharma helped create our mental health crisis

A polemic on the evils of the pharmaceutical industry needs to apply more rigour to its own argument
July 10, 2021

It’s been a great year for Big Pharma—especially here in Britain, where the government displayed considerable alacrity when it came to advance ordering Covid-19 vaccines; foresight that was notably lacking when it came to instituting the measures necessary to confine the pandemic. And of the drug companies caught up in the race to save Boris Johnson’s political career, none has had a better global press than the US giant, Pfizer. It teamed up with the German company BioNTech to develop its vaccine, two 0.3ml doses of which have been injected into my upper arm, the first in late January and the second in late April, thereby—in theory at least—delivering me from the enforced reclusion known as “shielding,” which Britons with serious underlying health conditions have had to endure.

But James Davies, the author of Sedated, doesn’t want such scientific success to distract me from what he argues are Pfizer’s more questionable activities. Indeed, he wishes to finger the drug company as one of the principal actors in the UK’s so-called “mental health crisis”: a crisis that the pandemic is—according to the psy-professions, at least—set to deepen, along with the demand for all manner of nostrums and panaceas.

For Davies, Pfizer helped Britain to become the heartsick man of Europe, and they did it by sponsoring the development of two questionnaires: PHQ-9 and GAD-7. There’s a reasonable chance that you will have encountered one or both of these in your GP’s surgery. The questionnaires, which take five minutes to complete, consist of multiple-choice questions about our mental states familiar to those undertaking psychometric tests in corporate settings. PHQ-9 aims to tell doctors if we’re depressed; GAD-7 if we’re suffering from anxiety. Davies impresses on us how “low the bar” they set for patients to be diagnosed with “moderate depression,” which, according to NHS guidelines, is sufficient grounds to be prescribed antidepressants. You only have to tick the boxes saying you experience poor appetite, troubled sleep and poor concentration every day for the past fortnight and—bingo!—you could win a prescription for Zoloft (sertraline), one of the most widely prescribed psychiatric drugs in the world, manufactured by—you guessed it—Pfizer.

Davies cites research published in the British Journal of Psychiatry that evidences a threefold increase in antidepressant prescriptions between 2002 and 2020. Last year, 75m such prescriptions were written by NHS doctors alone. Davies wishes us to bite down on this bitter pill, rather than simply swallowing it: for him almost all psychiatric drugs seem to be equally lacking in efficacy, while successive British governments have, according to Davies, helped in their over-prescription on ideological, rather than scientific, grounds.

The change in our treatment of mental illness in the 1970s, argues Davies, coincided with the advent of neoliberalism: a political philosophy based on its own chemical theory of human society, whereby the adjuvant of the unrestricted market would bring human reagents to their full productive potential. For Davies, the ideology espoused by Reagan and Thatcher—individual freedom of choice—and the market liberalisations their governments introduced in pursuit of it, are linked to those Pfizer-sponsored questionnaires.

What Davies sees as questionable psychotherapeutic approaches are challenged as well. Cognitive Behavioural Therapy (CBT) rests on the idea that negative beliefs—such as irrational low self-esteem—can be helped or annulled by systematic schooling in new coping mechanisms, including challenging those beliefs and associated neurotic behaviours. At its worst, CBT can sound—and look—little different to some sad soul standing in front of their bathroom mirror and chanting: “every day and in every way I am getting better.”

Improving Access to Psychological Therapies (IAPT), which includes CBT, so impressed Tony Blair’s Labour Party it endorsed it in its 2005 election manifesto; it is now a standard part of NHS care. It was attractive because it’s relatively cheap: between two and six sessions can be delivered by relatively unschooled psy-professionals, and because it seemed to offer outcomes for those suffering from depression and anxiety as good as the drugs did, thereby honouring commitments—again, by successive governments—to make access to psychotherapy as easy as to pharmacology. In fact, as Davies relates—leaning on research conducted by Michael Scott, who at the time was a clinical psychologist at Manchester University—the IAPT programme had distinct parallels with the promotion of psychiatric drugs by Big Pharma. There was little independent oversight, which allowed the “success” of the method to be determined by flawed statistical methods. “The reason IAPT claims 46 per cent of patients recover through therapy,” says Scott, “is because it only assesses the people in the final category; only those patients who have actually completed treatment.” If the number dropping out—about 50 per cent—were factored in, the programme could be seen to have much less efficacy. But still the coalition government sunk a cool half-billion into rolling out this mishegas nationwide.

Whether by allowing Big Pharma—and the psychiatric profession—to retrofit new “psychopathologies” by matching symptoms of distress to the drugs that supposedly alleviate them, or by removing social safety nets and employee rights thereby creating precisely these sorts of distress, the ideologues who rule over us have perpetrated a regime predicated on pseudo-science—or so Davies would have us believe.

In a way, Sedated can be seen as just another iteration of a centuries-old philosophical conundrum, perhaps best summed up by one of Morrissey’s couplets: “Does the body rule the mind / Or the mind rule the body?” For decades now, I’ve been writing articles and reviews limning the turf-war between opposing groups of psy-professionals: clinical psychologists and therapists such as Davies himself, who vehemently oppose Big Pharma, and who accuse the psychiatric establishment of neglecting the “social” in their espoused “biopsychosocial” model of mental illness; and neuro-pharmacologists, neurologists and psychiatrists, who accuse these critics of placing too much emphasis on such factors as poverty and alienating work, while neglecting the organic basis
of psychopathology.

For the most part, I side with those backing the talking cures rather than the swallowing ones: after all, as Davies succinctly points out, there remains no biological test for mental illnesses such as schizophrenia and bipolar disorder, and the net result of all that pill-popping seems to have been a worsening of outcomes. I reviewed Davies’s book Cracked: Why Psychiatry is Doing More Harm than Good, when it came out eight years ago, and a minatory-cum-hortatory remark of mine was used on the paperback cover: “chilling reading.” Because whatever criticisms its author may have of consumer capitalism’s impact on our psyches, he has no compunction about pushing his own books. The cover of Sedated features a pill packet tricked out to look as if it were the book, complete with the number of pages instead of pills.

What I find most unbelievable about Davies’s book is his evocation of a social democratic consensus that would supposedly have kept us all from getting mad as hell. In part Davies leans on the ideas of the old anti-psychiatric thinkers of the 1960s: Foucault, Szasz and Laing. Although of these, only the first is directly cited. Understandably so, perhaps: Laing’s art-revolution in the carceral asylum ended up with shit-smearing and stoned antics in squats; while Szasz’s assaults on what he termed “the therapeutic state” made him in his later years an unlikely ally of the Scientologists. Neither are the sort of allies that Davies wants to admit to having.

What with the paedophilia accusations, the lustre seems to be coming off Foucault as well. Yet Davies still writes “power embraces the ideas and practices that best serve its own aims and interests—ideas and practices that come to shape reality on the ground,” a woolly restatement of Foucault’s foundational notion: the “episteme,” or limiting constraint, is placed on the possibility of knowledge—and its allied discourses—by the exercise of hierarchical power.

Setting aside whatever criticisms can be aimed at Foucault himself—Madness and Civilisation is chronologically inaccurate when it comes to the history of the psy-professions, placing the cart of state-mandated confinement before the horse of the Enlightenment—the “social philosopher” would never himself have indulged in the personification of power. By contrast, for Davies, “power” seems to be a leviathan made of up of lots of little Thatchers, Reagans and Big Pharma executives and shareholders. And it’s a leviathan, he thinks, that has consciously and coherently undertaken its programme of mass sedation and maximised profits—such that one thinks, immediately, of Huxley’s Mustapha Mond, resident world controller of western Europe, handing down the pharmaco-hierarchical law to the malcontent Bernard Marx in Brave New World.

Davies’s argument thus parallels that advanced by environmentalists who identify the world’s principal polluters as the corporations who sell us stuff we don’t need, rather than we who buy it, and see our deliverance from the climate emergency as a matter of constraining production, rather than consumption. For the benighted zero-hours-contracted workers who shuffle along to the surgery only to have their perfectly reasonable—given their circumstances—depressions and anxiety supposedly medicated away, Davies undoubtedly has an angry compassion. And for the most part, I agree with his critique. But this book embraces a view on the mind/body problem that is as fabricated as Big Pharma’s blister-packs, and just as capable of inducing delusions.

Davies falls victim to the American habit of constructing a “narrative” for what is essentially a polemical work. He introduces his true philosophic inspiration thus: “In August 1844, two intellectuals in their mid twenties met at the Café de la Régence on the Place du Palais in Paris.” This sort of annoying locution suggests he himself was eavesdropping on Marx and Engels—and places their conversation on a par with that between himself and Nigel Lawson detailed a few pages earlier.

“If Davies wishes us to believe that the mind rules the body then he should take more care with his words”

Do these apparently small matters of style matter? Yes, they do—just as it matters that Davies consistently refers to luminaries such as Foucault, but never directly quotes them. For he wishes to slam Big Pharma for relying on interpretations of data that can only be adequately challenged if we’re prepared to examine the original studies and their methodologies, while relying on precisely these sorts of interpretations himself for his own argument. If Davies wants us to believe that the mind rules the body then he should take more care with words rather than relying on this sort of lazy alchemy when he writes about someone he agrees with: “‘it was really humbling to be there,’ she told me sincerely” is how he describes an encounter with “a young and dynamic professor of public health” speaking of her involvement in the Occupy movement. A page later Davies has her saying that as a result of multinationals’ promotion of genetically modified seeds in India, “hundreds of thousands of farmers were killing themselves under the resulting stress.” This is a “fact” he doesn’t bother to challenge, although a few key strokes would have told him the official statistics for suicide in India are well under 200,000 per annum for the entire nation.

What I’d charge both psychotherapists and psychiatrists with neglecting, as they pit social against biological factors, is having a coherent view of that other determinant in the “biopsychosocial” model: the human psyche. Both groups seem to me engaged in Weberian professional closure quite as much as anything else—diagnosing our ills for us, and thereby profiting in their own ways. But while some surveys have predicted a veritable tsunami of new mental illnesses as a result of the pandemic, others indicate that at least a third of Britons experienced the lockdown—and by extension, the pandemic itself—as a positive boon to their psychic wellbeing. Oh, and there’s that other pesky mental health statistic no psy-professional really wants to contemplate: rates of anxiety, depression and even psychosis all seem to decline when a society is at war.

Sedated: How Modern Capitalism Created Our Mental Health Crisis by James Davies (Atlantic, £18.99)