Lucette Davies reviews an already classic argument by James Davies on the damage that capitalism and profit seeking has done to the practice of psychiatry

James Davies’s book Cracked was described by Will Self as ‘chilling reading’. It describes how psychiatry has put riches and medical status above patients’ well-being. It is a damning indictment of capitalism. It would be easy to assume from the title that Davies is anti-psychiatry, but read on and you realise he is simply critical of how psychiatry is affected by capitalism. He recognises good work is done in the field but believes reform is needed.

The crisis in psychiatry and collapse of capitalism

Since the 1970s, increasing numbers of people are being diagnosed with a mental-health disorder and they have had a decreasing chance of recovery. Something is clearly going wrong. Since 2008, we have also been witnessing a profound crisis of capitalism in its current form, and we are now all far more likely to be suffering from its effects. This book may be nearly ten years old, but the need for people to pay attention to its central message is now even more acute.

I began reading this book in an attempt to understand my own extremely painful experiences in the mental-health services. However, it has given me as an activist a clear understanding of why the very system we live in will work to hamper any sense of well-being we may seek. The book helps to explain why, if left unrestrained, the system threatens the survival of us all.

Capitalism is bad for our health

When Davies interviewed consultant psychiatrist Pat Bracken, he stated that: ‘Capitalism can only continue by constantly making us dissatisfied with our lives’ (p.278). In the same way that we are told we need a new TV, a miraculous new face cream or a bigger, better car to feel good, psychiatry is marketing pills as easy solutions to normal human distress. Our economic system relies on us wanting to buy and spend.

The utter greed of the bankers who caused the financial crash in 2008 is now mirrored by the greed of big corporations who are raising prices exponentially while wages stagnate. It is that same greed for profits in the pharmaceutical corporations that is failing psychiatry today and all who suffer from the system as patients. The utter corruption we are witnessing today in Government and in big business has also undermined the idea that psychiatry can be trusted to be scientific.

In his first chapter, Davies discusses the alarmingly unscientific process by which psychiatry’s ‘bible’, the Diagnostic and Statistical Manual (DSM), was produced in the US. The DSM is a catalogue of mental illnesses and disorders with a list of diagnostic criteria given for each, but with each successive version of the DSM, more and more disorders are identified.

However, by the 1970s the DSM and psychiatry were in a real crisis. Professor Rosenhan had conducted an experiment that showed up how easily sane people could be labelled as sick (p.6). Psychiatry was also beset with problems relating to disagreements between psychiatrists about diagnosis.

Under the leadership of Dr Spitzer, a team of fifteen psychiatrists were assembled to begin the writing of the DSM III to fix this crisis (p.13). However, Davies reports that even after the DSM III had been published, when a group of psychiatrists were asked if diagnostic reliability had increased, ‘a full 86 per cent said that reliability was still poor’. Davies goes on to say: ‘Another study published in 2006 showed that reliability has not improved in 30 years’ (p.18).

The DSM is a hugely influential manual and worldwide co-operation between countries has meant reliability is no greater outside of the US. However, the DSM only identifies very few disorders where a biological pathology has been evidenced. Most disorders listed in the DSM are there because of a consensus of opinion between those fifteen psychiatrists of different groupings of symptoms they have witnessed in their work (p.22). But how much of what those psychiatrists witnessed in their work was just normal human distress? Did it need labelling as a mental-health condition?

The harm that comes from pathologizing distress

Davies returns to this theme of how damaging it is for ordinary human distress to be treated as a physical disorder on numerous occasions in the book. His belief is that life inevitably involves distress, that it is a part of being human. Distress is a vital part of life. Distress has a reason, it is a motivation for change, it is confirmation that something or someone we have lost was important to us.

For myself, the experience of being held in a psychiatric unit was in itself a source of distress, and just being given tablets to cure me was dehumanising. It ignored my very human experiences and suffering. Instead I felt like some sort of broken object, sat waiting to be fixed like a car that needs its spark plugs changing. It’s almost laughable now to think of those endless ward rounds when the psychiatrists would scratch their heads and wonder why my depression hadn’t lifted. But all they would consider doing would be to give me more tablets. I went years without being able to swim in the sea or listen to an orchestra, and I certainly never felt I was treated with respect. I recovered after many years, and countless tablets and treatments, when somebody decided to talk to me and listen.

Davies discusses in depth how misery has been pathologized (Chapter 3). He asks the questions:

‘At what point does the medicalization begin to undermine the health of the population? At what point does it begin to turn what should be a matter for spiritual, philosophical or political understanding and action into an issue that can be managed by medicine alone?’ (p.43).

It is not only Davies who has reacted against the increasing number of so-called mental-health ‘disorders’ that get identified each time the DSM is rewritten. By the time the DSM V was being written, even grief was being pathologized. Davies describes how: ‘A chorus of dissent repeated in over 100 critical articles in the world press’ (p.55) were reacting to the inclusion of grief. Yet, in the end, prolonged grief disorder was listed in the published version. Including a disorder in the DSM opens up the possibility for big pharma to produce new drugs. Lowering the bar at which individuals can be diagnosed with a disorder can increase sales of those drugs.

In Chapter 4, Davies goes on to discuss the nature of psychiatric drugs. He reports that ‘the pharmaceutical industry makes £12.5bn each year from antidepressant medications’ (p.58), and that doctors and patients alike are convinced of their effectiveness. However, a meta-analysis of trials showed that patients showed no greater improvement on antidepressants than on placebo drugs. And all patients fared better with psychotherapy than drugs (p.64).

Davies goes on to describe in Chapter 6 how psychiatric drugs can change a person’s personality in a way that the person themselves may not recognise. He explains how antidepressants are not returning us to health but they ‘rather manufacture a new state of mind, and often an unnatural state’ (p.99). In my own experience, I have witnessed friends who are heavily medicated with psychiatric drugs who can seem like an empty shell of the person I had known.

Perhaps this altered state of mind can be helpful to alleviate painful emotions and give us a chance to make changes to our lives so the drugs are not needed. Yet, this is not the case if we are told that those drugs are a cure and we must stay on them for life. And not if we are left finding the withdrawals from those drugs unbearable.

In Chapter 9, he discusses the utterly immoral process whereby pharmaceutical companies pay psychiatrists and universities to sell their product, and how it is near impossible for any patient to find out if their psychiatrist is being paid to promote the drug they are being prescribed. He discusses what he terms as ‘psychiatric imperialism’ in Chapter 12. In this chapter, he discusses how the West has exported their pathologizing of distress to countries more likely to see it as a result of social or psychological problems.

A way forward from this crisis in psychiatry

Most importantly, Davies discusses in Chapter 12, ‘how to fix the cracks’. Pat Bracken explains that: ‘there is growing concern that this enormous tidal wave of prescribing is actually causing major problems, not least of all by increasing mortality rates of people experiencing mental illness’ (p.271).

Although this review has criticised the use of psychiatric drugs, I myself and many others have taken these medications for years. They are not easy to withdraw from, and anyone who wants to stop taking medications should approach doing so with extreme caution and preferably professional support. But there is an array of information out there on how to approach withdrawing.

This chapter finishes by explaining four propositions for what needs to be done to tackle the crisis in psychiatry (p.275). For myself, I would have liked to see this book use the crisis in psychiatry as powerful reason for brakes to be placed on the rampant capitalism we live with. There is nothing I would like more than to see the psychiatric system reformed. But if that could be achieved by us by taming capitalism, then that would be even better.