Sedated

In England last year [2020 given the book was published in 2021], 7.4 million adults were prescribed an antidepressant in the NHS, compared to only 1 million who were referred for a psychological therapy. And this is not because people prefer the drugs; the majority of people consulting a GP for help would prefer a talking therapy⁴³ or some form of social support. It is rather because our services are bereft of psychosocial alternatives, leaving 1 in 10 people having to wait over a year to access NHS therapy (and the rest often waiting for many weeks or months).⁴⁴ Thus drugs have become the overwhelmingly prevalent mental health intervention not because of their high safety, efficacy and desirability, but due to decades of chronic underfunding of services, the dominance of powerful pharmaceutical/psychiatric interests, and a drug-first approach that has neatly aligned with the preferences of late capitalism (as we will later explore). In this sense, they have thrived not because they have improved the emotional life of the nation (the opposite, in fact, is more likely to be true), but because they have served as a sticking plaster for deeper maladies caused by structural problems afflicting our mental health sector and wider economy.

The fact that well-being programmes such as MHFA [Mental Health First Aid] completely veer away from any of these thorny social concerns is perfectly understandable from the standpoint of their own market ambitions. To sell their wares effectively they have to be attractive to their customers: the companies and organisations that pay for them. And what is more attractive than services that relocate responsibility for employee distress away from the organisational and social conditions of work itself and towards the more private structures of self. The whole business model of workplace mental health consultancies, in other words, fundamentally rests on a message that organisations will happily pay for: one that favours back-to-work policies and exonerates working conditions, while at the same time enabling organisations (and the government that helps fund these programmes) to declare sanctimoniously that they are tackling poor mental health.

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While many academics therefore see things critically, the growing popularity of these programmes suggests that most of us probably do not. And perhaps we do not for understandable reasons. Such programmes, after all, target managers and employees, who are often struggling, tired and overworked; who often lack the time, job security and in some cases the critical resources needed to challenge the status quo. They also overlook the widespread meaninglessness of much modern work, while evading critical reflection on the economics that shape the employment market. By subtly accepting that increased worker output and productivity, rather than the nurturance of wider human potential, should be the primary goal of their interventions, these programmes give simple and attractive solutions to problems that have far deeper and more complicated roots, and provide moral cover to both corporations and politicians who claim, in good faith, that they take mental health seriously via the services and funding they offer.²⁷

Given the evident benefits such consultancies bring to organisations, it is little wonder that they continue to thrive despite there being no evidence for their effectiveness – no research showing they make people less distressed and more productive at work. But perhaps, from the standpoint of company and organisational interests, being effective is not really the point. After all, when push comes to shove, these programmes still deliver significant value for money, by largely helping to control the narrative about what causes workplace distress. By removing difficult work experiences from the domain of public discussion, and placing them into the private domain of the consultancy room, the negative effects of modern work can be medicalised, individualised and depoliticised and thus more safely, quietly and confidentially diffused.

Indeed, as Giles Fraser put it to me: ‘Capitalism doesn’t want your inner life to be completely fixed – it is happy for you to be a functional depressive or a functional alcoholic, because in both instances you are still a functional consumer and that’s what really matters.’ In this sense, the preferred emotional state for late capitalism is a state of perpetual ‘functional dissatisfaction’: functional to the extent that you will continue to work, and dissatisfied to the extent that you will continue to spend.¹ Late capitalism does not generate just the conditions of distress, but the materialist, apolitical and profitable interventions deemed to remedy it – interventions that, as we will now see, chime with the materialist zeitgeist of our times.