Showing posts with label anti-depressants. Show all posts
Showing posts with label anti-depressants. Show all posts

Friday, 4 October 2013

The blinkers of liberalism: why collaboration is not cause



“I don’t think it helps anyone to see the current imbroglio as simply a function of late capitalism in its most aggressive aspect,” wrote Will Self a couple of months ago in an essay about the success of big pharma in enlisting the cooperation of the psychiatric profession in its demonic bid to sell billions of anti-depressant pills around the world. “I’m afraid,” he went on, “I have to mouth the old lily-livered liberal shibboleth at this point and observe that, yes, we are all to blame.”

Pardon me, but I’m going to be unhelpful. I’m returning to Will Self’s article, not only because I've got OCD and will devote the next 28 posts to it (including his use of the phrase ‘late capitalism’ which really gets my goat) but because it illustrates a ubiquitous misconception in understanding how the problems of our society arise.

Self, who essentially defines himself as a liberal, makes a mistake emblematic of that world-view, in confusing collaboration and cause.

Broadly speaking, reactions to the flaws or problems produced by contemporary society that become impossible to ignore (the financial and economic crisis is a prime example), fall into three camps:

1. Conservative. The economic system, said the free market think tank, The Institute of Economic Affairs, at the dawn of the neo-liberal era in 1978, has no impulses of its own aside from the desires of the people that comprise it. Conservatives emphasise personal responsibility and believe that our economic system merely mirrors our own desires, so any malfunctioning or perverse outcome, is ultimately our own fault. The UK Conservative Defence minister, Philip Hammond blames the economic crisis on “consenting adults” who went on an unsustainable debt binge. Another English conservative, Tim Montgomerie, responds to calls for more regulation by asking ‘how do we put limits on ourselves?’ However, this diffusion of responsibility is only invoked when things go wrong. Success, by contrast, is attributed to the efforts of a talented few. “You have the courage to tell the masses what no politician told them,” wrote the post-war free market economist Ludwig Von Mises in a letter to Ayn Rand. “You are inferior and all the improvements in your conditions which you simply take for granted you owe to the efforts of men who are better than you.”
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2. Liberal. It is here that we first encounter the idea that corporations may have a share, even quite a large share, of responsibility for society’s ills. “If you aren't familiar with the fact that almost all drug trials are funded by those who stand to profit from their success,” says Self in his essay, “… well then you jolly well should be.” But corporations are not alone when it comes to apportioning responsibility. They have a willing accomplice – people. “Although it’s nice to reserve the blame for banks which made lending too easy,” asserts John Lanchester in Whoops!, a book about the credit crunch, “the great British public is just as much to blame.” The insatiability of wants and power relationships, say Robert and Edward Skidelsky in their book How much is enough?  combine to produce “an ethic of acquisitiveness, which dooms societies to continuous, objectless, wealth creation.”

3. Leftist. The problems are systemic. To blame individuals, be they consumers, men or bankers, for disastrous outcomes is just finger pointing and a way of distracting attention from what is actually happening. Employees and consumers, rationally following the paths set out for them by this economic system, will inevitably generate booms and busts and seemingly intractable social problems. As an example, consider how consumer borrowing leapt up in Britain after 2000 just as earnings growth slowed to a trickle. The cause of the financial crisis of 2007/8 was not “reckless banks” or irresponsible borrowers but too little money at the base of society, leading to the implosion of derivatives such as mortgage backed securities, and too much money at the summit, destined for speculation. “Few recognise the system as the problem,” says Marxian economist, Richard Wolff, “rather than this or that group reacting to the system’s demands and pressures.”  According to this systemic approach, consumerism is not a regrettable quirk of human nature, but the glue holding the system together, and a glue that has lost much of its adhesiveness.

Consuming ants

The criticism of this perspective is that it robs people of a sense of their own volition. “Even if consumer preferences can diverge from real needs, they cannot be entirely independent of those needs; they cannot be simply “instilled” in us by the “productive apparatus” or some other such monster,” say the Skidelskys in How much is enough?  “To assert this is to deny individuals all agency, to reduce them to ants or drones”

At a common sense level, the liberal perspective conforms to what we intuitively know. “It might seem as if it is the average citizen, you and I, who are the main problem,” says a writer for social ecologist magazine, New Compass. “Who else is driving polluting cars, buying plastic toys or eating food grown on the other side of the planet?"

We can blame advertising, but advertising cannot shape desires out of nothing, protest the Skidelskys. It cannot, they point out, persuade us to buy dog turd. Advertising has to have something to latch on to in the first place and that something is “intrinsic” human wants.

But the liberal perspective is, in my opinion, a gigantic red herring, a major stumbling block that needs to be overcome to understand the society in which we live. Of course, humans are to blame - our intrinsic desires make this economy function. But you can say the same of any social system; potential human desires are not just consumerist. Nazism rested on human desires, just as this neoliberal capitalist society does, just different desires – the desire to belong, to merge into a larger whole, not to think,  and to blame others for things that are not their fault (a facet of “human nature” which never went away and is returning with avengance). The question that needs answering is not why human nature is always so corruptible, so weak, so easily directed, but why certain “intrinsic” human desires are encouraged endlessly, in particular societies, but others are left to rot. In short, what drives this society, the one we inhabit and are so loath to seriously interrogate?

A cracked mirror

 Will Self embodies the liberal capacity to see and yet not see. In his Guardian essay, he refers approvingly of James Davies’ book, Cracked: Why Psychiatry does more harm than good. “The sections of his book,” he writes, “that deal in particular with the way big pharma has moved into markets outside the English-speaking world and effected a wholesale cultural change in their perception of sadness (rebranding it, if you will, as chemically treatable "depression"), simply in order to flog their dubious little blue pills, make for chilling reading.”

Yet, at the same time, Self insists, “we” are to blame, even though we find it hard to acknowledge this uncomfortable responsibility – we go to the doctor feeling awful and we acquiesce in whatever they suggest (in this case swallowing SSRIs) will make us feel better. To add weight to what Self is saying, consider the opinion of Dr Ramin Mojtabi, a professor in public health in the US. “It’s not only that physicians are prescribing more [anti-depressants], the population is demanding more,” he says. “Feelings of sadness, the stresses of daily life and relationship problems can all cause feelings of upset or sadness that may be passing and not last long. But Americans have become more and more willing to use medication to address them.” This is the perfect encapsulation of the liberal case; pharma companies may be pushing the anti-depressants on to us with machine-like eagerness but we are only too happy to oblige. In fact we are biting their hands off to get them.

On closer inspection, though, the liberal case does not add up. There would be no need for pharma companies to effect a cultural change in non-English speaking countries if the demand were already present. They have to first create the demand, effect the cultural change and then watch the profits roll in. Secondly, there is an obvious reason why anti-depressants are the current drugs de jour.  They are eminently suited to our neo-liberal, capitalist societies because they have a reputation (merited or no) for enabling people to go on functioning through mental illness. And to function, to hold down a job, is exactly what people must do. They can’t afford to take time off to be ill. In this way, anti-depressants are remarkably similar to the very popular flu “remedies” which ameliorate flu symptoms. But the only cure for flu is rest. The concept of rest now has unmistakable air of decadent forbiddenness.

But the cart before horse logic of liberalism is irresistible to some. “Americans’ appetite for cheap clothes is one of the strongest of the economic forces that led to a boom in Bangladesh,” says an article in the Wall Street Journal, referring obliquely to the building collapse in Dakar which killed 1,129 garment workers “with the resulting race to add manufacturing capacity,” the article continues, “setting the stage for a series of horrific accidents.” The problems are demand-led, in others words. Western consumers’ apparently insatiable demand for cheap designer clothes means that people on the other side of the world are paid peanuts and work in terribly unsafe, sweatshop conditions and are sometimes left buried under tons of rubble. Corporations are merely the middle-men that reflect this insatiability.

But this has it precisely backwards. Consumer demand in the West didn’t inspire corporations to relocate production in China, Bangladesh or Vietnam. The prospect of a massive hike in profits, based on dirt poor wages, did. The technical term is global labour arbitrage, defined by the neo-liberal Economist magazine as “taking advantage of lower wages abroad, especially in poor countries.” According to economist, Charles Whalen, “The prime motivation behind offshoring is the desire to reduce labor costs … a US-based factory worker hired for $21 an hour can be replaced by a Chinese factory worker who is paid 64 cents an hour [and Bangladesh is even cheaper] … The main reason offshoring is happening now is because it can.” (it should be pointed out, in passing, that the transfer of enormous profits back to the US, Europe and Japan, enabled by global labour arbitrage is a prime cause of the financialisation and speculation that lie at the roots of economic crisis).

 Fake plastic flowers

I am not denying for a second that many consumers in Britain and American are hooked on cheap designer clothes. Or that, in the words of George Monbiot, we have entered a state of “pathological consumption” that successfully hawks silver plated ice cream tub holders or talking Darth Vader piggy banks. Or that many people unhappily munch anti-depressants at their own behest. I am not reducing people to ants or drones. But consumerism, not matter how enthusiastically or mindlessly it is practised, is an outcome, not a cause. To try to understand the world without taking into account the seminal role of institutionally selfish entities called corporations, dedicated to maximizing profit and sales, growing and achieving, if possible, monopoly status, is not to understand it at all.

And it is this deficit of understanding that means there is something missing in liberalism, no matter how perceptive it is in other ways. The book mentioned above, How much is enough?, is an extremely interesting, historically nuanced, thought-provoking book about how rich societies have not actualized John Maynard Keynes’ prediction that they would slow down, and enable people to enjoy the good life, and not spend their days solely dedicated to producing and shopping and competing with others. It is co-written by renowned Keynesian economist, Robert Skidelsky. Yet it contains the following assertion: “Experience has taught us that material wants know no natural bounds, that they will expand without end unless we consciously restrain them. Capitalism rests precisely on this endless expansion of wants.” I can’t be the first to notice that this logically makes no sense. Wants will naturally multiply unless some outside agency representing wisdom or the good life (the state?) doesn’t suppress them. But capitalism exists to expand these want ad infinitum for its own benefit. So why should wants expand exponentially of their accord without capitalism? (and I mean capitalism, not the misleading pseudonym, “market economy”) What evidence is there that they will?

This is not to minimize the immense difficulty of changing this society, the fact that, in the words of one commentator, “capitalism has buried itself deep into our psyche by the consumerisation of our lives”. But the task is rendered impossible by misunderstanding the problem in the first place.

To misquote the anarchist Emma Goldman: “capitalism gets the human nature it deserves”.

Tuesday, 13 August 2013

A plague of depression or sadness rebranded - what's the truth about capitalism and mental illness?


An essay, published a couple of weeks ago by the novelist Will Self, caught my eye because it embodies an interesting conflict between two differing left-wing critiques of corporate capitalism. They appear to be making diametrically opposite points yet both stem from an anti-capitalist viewpoint, or at least display a healthy scepticism towards the “truths” of our corporate society.

Self, who has previously been a psychiatric patient, was concerned to take on the psychiatric profession and  (as the stand-first puts it) its “disease mongering”. Unable to cure severe mental pathologies, Self argues, psychiatry has instead turned to treating “less marked psychic distress”. Aided and abetted at every stage by pharmaceutical companies, doctors now create diseases to fit the drugs available. What used to be ordinary sadness has been rebranded as depression, an illness that can conveniently be combated by the prescribing of anti-depressants  - a dispensing of billions of pills to correct an alleged chemical imbalance in the brain that coincidentally makes fantastic profits for big pharma.

“The sad are becoming oddly co-morbid (afflicted with the same sorts of diseases) with the mad,” writes Self.

Selfish capitalism and it discontents

Contrast this with the claim by Mark Fisher, author of Capitalist Realism, that neo-liberal capitalism is generating a “mental health plague”. Depression is now the condition most treated by the National Health Service in Britain, says Fisher. According to clinical psychologist Oliver James the “selfish capitalism” of Anglo-Saxon societies is causing an acute intensification of emotional distress ; an epidemic of depression, anxiety, substance abuse and personality disorder. James cites World Health Organization surveys: 26% of Americans experience an episode of “mental distress” every year. In Britain, the number is one person in five.

Here is James speaking:



So one side identifies a contagion of mental illness, while the other says it’s all a plot to uphold the prestige of psychiatry and supply pharma corporations with a steady profit stream. Who’s right?

At the risk of being diagnosed with an incurable case of fence sitting, it seems to me that both of these positions, on the surface utterly incompatible, may be true.

Depression x 1000

There is undoubted evidence for the veracity of what Self is saying. The arrival of Prozac and other SSRIs in the late 1980s coincided with a thousand-fold increase in the diagnosis of depression. It would be extremely difficult to honestly argue this had nothing to do with efforts of drug companies to market anti-depressants. And this initial anti-depressant spurt has since become a biblical flood. In 2011, 46.7 million prescriptions were written for anti-depressants by the National Health Service in England, an increase of 9.1% on the previous year, and an avalanche of pills compared to the 9 million prescriptions signed off in 1991.  But though “psychic distress” - to use Self’s term - has clearly been turned into chemically treatable depression, that doesn’t mean the distress was a fiction, or that the distress hasn’t increased, or that it was simply sadness given a medical name. There is, it seems to me, a large space between sadness and full blown mental illness. And a lot has been happening, in the last twenty or thirty years, in that space.

Ordinary and extraordinary sadness

Self himself makes the distinction. “But what has made it possible for someone recently bereaved or unemployed,” he asserts, “to have a prescription written by their doctor to alleviate their ‘depression’ is, I would argue, very much to do with psychiatry’s search for new worlds to conquer, an expedition that has been financed at every step by big pharma.”

Bereavement and unemployment are, I would argue, two completely different states. Bereavement is ordinary, though it doesn’t feel ordinary, sadness. It’s impossible to go through life and not be bereaved and feel its emotional effects. Unemployment is, by contrast, very much a socially constructed state. In the first place, unemployment has only been around for 200 years or so. Secondly, it’s much more acute now than it was forty years ago (from 1950 to 1973, UK unemployment averaged 1.6%). Lastly, its effects on an individual depend very much on how society treats it. Post-capitalist economists such as Richard Wolff and David Schweickart have argued that, in a more humane society, people that have to be laid off by enterprises would automatically be offered jobs or training elsewhere. This is everyday practice now in the Mondragon federation of worker co-operatives, comprising 256 companies employing 83,000 people, located in Northern Spain.

By contrast, what British society does is to make unemployment the personal responsibility of the person who is unemployed. Unemployment – a social problem if ever there was one - becomes an individual problem. The result is self-blame and, in a society that is intensely comparative, all the ingredients for mental distress, not just sadness, are laid. It is interesting that the root causes of the emotional distress identified by Oliver James in 2008’s The Selfish Capitalist (a book written before the financial crisis) – stagnating real wages, the growth of short-term, service industry jobs (see the rise of zero-hours contracts) and an exaltation of the consumer habits of the rich – have only become more prevalent. So why shouldn’t mental anguish have got worse?

Diseases, disorders and effects

The key to understanding what has happened, I think, is to separate social effects from their pathologisation, the turning of states of mind and behaviour into a “disease” which can then be treated by drugs. This pathologisation may be entirely unjustified, just suiting the need of pharma companies to make lots of money from selling pills, and indeed the pills may not actually work (Self says that the chemical imbalance theory of depression, on which SSRIs are based, is “essentially bunk” – he may be right, I don’t know) But all that doesn’t mean the social effects are not real. “The vast number of ‘hyperactive’ children in the US prescribed Ritalin is so well attested that it’s become a trope in popular culture,” writes Self. True, but I’m not convinced that labeling trends as a medical disorder, means that the trends themselves – difficulty in concentrating and impulsive behaviour in this case – are not genuine. Likewise, I don’t believe that the rise in mental distress is a myth.

Valium nation

To take a historical example, millions of prescriptions were written for the tranquilizer, Valium, a predecessor of anti-depressants, in the 1960s and 1970s. The drug quickly gained a reputation for being “the housewives’ choice”. It provided a release from the psychic consequences of an extremely restricted life. The problems for these women were pathologised and the symptoms they suffered from chemically anesthetized. But that didn’t imply that the underlying issues – a life limited to motherhood and caring and confined to the home – didn’t exist, or that doctors somehow created them, as most people, now the vast majority of women go out to work, would recognise. Why can’t the same be said for anti-depressants?

The book, The Spirit Level, provides persuasive evidence that Anglo-American societies have become more anxious, if not more depressed. The authors cite the work of American psychologist, Jean Twenge, who looked at 269 studies measuring anxiety in the US from 1952 to 1993. She found a continuous upward trend. By the late 1980s, the average American child was more anxious than child psychiatric patients in the 1950s. Anxiety, as far as I understand, is related to depression, though not as extreme. You can’t explain away these findings by saying it’s all down to doctors, egged on by pharma companies, discovering anxiety where previously it didn’t exist. Prozac was first released in 1988, just five years before the period of study ended.

I’ve little doubt that Self is right and psychiatry and big pharma, have, for different reasons, created diseases and pathologised distress. But that is only half the story.