In recent months, a long-standing debate in the field of mental health has resurfaced, generating volatile discussions on social media and in the press. This debate revolves around the critique of over-medicalisation and whether this critique truly serves the public good. Traditionally, this critique has been used by left-wing activists and scholars to advocate for more de-pathologised, humane and psychosocially informed mental health care. However, the critique is now also being employed by some right-wing politicians and commentators, sometimes to argue against providing any care at all. This has caused confusion within the professional and service-user communities, leaving many uncertain about whether to align with this critique or not.
To clarify this confusion, I will outline here two distinct critiques of over-medicalisation that highlight the growing divide between left-wing and right-wing perspectives. By understanding these differences, we can better navigate the debate and determine where we stand in relation to both positions.
Both left and right-wing critiques start from the notion that we are indeed over-medicalising ever more domains of emotional and mental life, arbitrarily expanding the definition of āmental disorderā to capture experiences that werenāt previously considered in medical terms. This has led to increasing forms of distress being reframed as pathology requiring medical (mostly pharmacological) interventions. Both sides broadly agree that this trend is generating significant harms, but they differ considerably (even fervently) on what they consider those harms to be.
For the right, over-medicalisation is seen as placing an increasing burden on state resources and social care systems (and this, for them, is a serious social ill). The more we unnecessarily spread the reach of medicalisation, the more unnecessary claims on the public purse. Some on the right go even further, asserting that seeking a mental health diagnosis has become so normalised (and easy) that people are using them to game the system. This view was expressed by the previous UK Prime Minister, Rishi Sunak, who claimed that psychiatric labels and sick notes were being widely exploited to escape work. His proposed solution was to make it harder to qualify for sick leave and health support, aiming to reduce government spending on disability and healthcare.
A core assumption of this right-wing critique, as I explained in The Guardian, is that most of the distress being wrongly medicalised is too mild to justify state support. This assumption declares that by lowering the threshold for what is deemed emotionally tolerable, over-medicalisation has created artificial needs for support. A similar point was echoed in a recent Telegraph article titled āThe Mental Health Con is Bankrupting Britainā, which argues that declining workplace resilience is fuelling worklessness; an occupational idleness that over-medicalisation validates and funds. Rather than increasing mental health spending, the article insists, we should restrict benefits and make returning to work (and resilience) the central route to health.
While such right-wing critiques place the burden on individuals to toughen up and self-manage their distress (unless it is of the severest kind), the left-wing critique, in stark contrast, squarely rejects the idea that over-medicalisation is encouraging malingering or false claims on the state. It rejects the notion that the suffering being mischaracterised as āpsychiatricā is somehow unreal or undeserving of support. For the left, people are indeed suffering, but not from the problems the medical model thinks. They are suffering from multiple and complex social, financial and psychological determinants that require non-pathologising social, relational, psychological & economic solutionsānot medical. So yes, we need more funding for services, argues the left, but not for more of the medicalised and failing same. We need to tackle the social determinants of distress, boost psychosocial provision, while upscaling robust financial support where necessary. (Please see the reading list below for a list of relevant left-wing critiques.)
The left-wing critique of over-medicalisation, however, goes further, arguing that medicalisation plays a central role in perpetuating and upholding many dominant social injustices of late capitalism. As the late cultural theorist, Mark Fisher, put it:
āThe current ruling ontology denies any possibility of a social causation of mental illness.Ā Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capitalās drive towards atomistic individualization (you are sick because of your brain chemistry). Second, it provides an enormously lucrative market in which multinational pharmaceutical companies can peddle their pharmaceuticals (we can cure you with our SSRIs). It goes without saying that all mental illnesses are neurologically instantiated, but this says nothing about their causationā¦. This requires a social and political explanation; and the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.ā
In short, for the left, over-medicalisation harmfully commodifies our suffering for vast pharmaceutical profit (incentivising the denial of drug harms and the exaggeration of drug benefits), depoliticises distress by framing it as an individual issue rather than one rooted in broader social dysfunctions, and undermines community solidarity by isolating struggles as personal rather than collective. By pathologising distress, it exonerates harmful social, occupational, and financial systems, and by privatising distress it frees neoliberal governance from tackling systemic causes. In this way, over-medicalisation has become a handmaiden to the neoliberal status quoāenabling and abetting itāa key argument I expand in my book Sedated: Why Capitalism Is Causing Our Mental Health Crisis.
As a long-time left-wing critic of over-medicalisation, I find it increasingly troubling that the crucial distinctions discussed above are being blurred in the minds of many. Sometimes this confusion arises from an innocent lack of understanding, but often it is deliberately fuelled by those opposed to the critical position. In defending the overly-medicalised status quo, some have actively sought to blur the lines between left- and right-wing critiques, suggesting that there is no distinct left-wing critique. They imply that anyone questioning over-medicalisation must be aligned with the right and therefore not worthy of consideration.
Anyone acquainted with these debates will recognise the sources of these arguments, as discussed and exposed here. These are the people who dismiss all critics as āSzaziansā (right-wing), create skewed narratives about who the critics āreally areā, and manipulate the history of critical and anti-psychiatry to fit their current ideologies and agendas. While it’s unfortunate that this kind of behaviour occurs at all, it’s hardly surprising, as left-wing critique has always challenged powerful vested interests that prefer not to be disturbed. What is important is to rise above misrepresentation to apprehend the essence of what the actual arguments areāsomething I have attempted to do, at least cursorily, above.
This is an interesting critique. I’m from the U.S. I have heard more right-wing (both Christian and alt-right) commentators here talk about over-medicalization, too. Not so much from a perspective of state burden, but just as being ineffective or ungodly or unjust.
Allie Beth Stuckey is a popular conservative Christian commentator. She has a show called “Relatable” and has interviewed a lot of people about the over-medicalization of mental illness. Dr. Roger McFillin, Brooke Siem, and a couple others.
I’m glad that she’s increasing the conversation. She is right to point out how people are over-pathologized, but I still think that she has this idea that if people just got Jesus in their lives and plugged into church, they wouldn’t struggle with their mental health anymore. As if it’s that simple.
We also have a lady named Abigail Shrier who has written some books. One is called “Irreversible” and it’s about the trans-gendering of children. She went onto write another book called “Bad Therapy,” about how therapy for adolescents is ineffective and is making them worse. I have not read her books, but I’ve heard her podcasts and I agree with most of what she said. Taking kids who are just struggling with an identity disturbance and then giving them a life-altering gender transition is wrong, rather than giving them the time and support needed to work through those hard feelings.
I also agree with the therapy thing. I found therapy ineffective as a teen, but I fear that she has swung the other direction, and just wants to go back to taking a “tough love” approach with teens who are struggling with real tough stuff.
I have heard right-wing critiques about the burden on the state, but I’ve also heard it more from the perspective of feeding Big Pharma and how healthcare is all about money. Which it is.
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Itās simplistic to divide people (worldwide no less) into right and left wing. Iāve seen many left wingers support forced psychiatric treatment. For example in 2023 California passed a law that could result in more people with untreated mental illness and addiction issues to be detained against their will and forced into treatment. On the other hand RFK, who endorsed Trump, has criticized the overuse of prescription drugs for children, teens and adults. Both right and left legislators supported the 21st Century Cures Act, which has made it far easier for the FDA to approve ineffective drugs.
To associate overmedicalization with capitalist injustice is another oversimplification, especially when left wing critics are idealized as the good guys and right wing critics demonized as the oppressors. It is sad to me that MIA has become so increasingly politicized.
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Agreed. This article made me sad about what MIA is doing. It unnecessarily marginalizes anyone but the purest of heart, defined of course by one side of the fence. Gross.
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James:
Thanks for your assistance with my book.
Perhaps in this era of captured regulatory agencies and “public-private partnerships,” the old dichotomy of Left versus Right doesn’t mean a whole lot anymore. That’s why we seem some apparently strange bedfellows coming together in the Critical Psychiatry movement (and, more recently, the Covid Skeptic movement).
Perhaps we need to re-frame the debate between those who value human life and works, and those who do not.
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Capitalism has an unfortunate effect of valuing human work as a way of extracting value but not valuing human life too much. The, “left,” however has become very authoritarian and seems to have forgotten it’s original purpose which was to increase human freedom.
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Well said.
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Thank you for your service in this area. There is no doubt the bio medical reductionist theories that hold psychiatry and mental health workers hostage have done far more harm to individuals and society than good yet they continue to get billions of tax dollars routed their way. The evidence is in FAIL. FAIL. FAIL. DE-FUND. Divert tax payer funding to innovators and grassroots movements like THINK Consulting in Australia provided under leadership of Renee Knapp a teacher that had enough.
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What about us independents, which I think is about 40% of all Americans? I agree with others here who point out the simplistic beliefs of those who believe everyone needs to be divided between right and left.
It’s kind of like the psychiatric reductionism of the scientific fraud based psychiatric and psychological industries. No, there’s more than just two choices, at least there most certainly should be such.
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Useful snappy piece to forward to others caught up in this neoliberal mess. I see pretty much daily at work people talking up or playing on a range of physical and emotional sufferings in order to avoid work and maintain benefits. If your only option is to have to go back into a work situation that Radiohead once sang ‘slowly kills you’ then you will be driven to avoid this at all costs. Especially if your resource starved and have no way to retrain, up-skill or otherwise escape the drudgery of mind and body breaking work.
For those that have managed to endure a significant part of their ‘working lives’ doing such god awful destructive work and have indeed suffered a slow death and live with varying degrees of physical and emotional pain and suffering avoidance of more of this sounds like a wise option.
Sadly for many such people they are now faced with a battle of terrible guilt, embarrassment and humiliation at having learn how to perform their sickness or sell it to the DWP.
Then comes months and years of being suck in this performative, guilt ridden mess that often reinforces and compounds whatever damage working life has already created.
For those that have lived their lives on benefits its usually even more miserable. Seems to me there are very few that do manage to remain relatively well, learn sickness selling with skill and manage to live an ok life on benefits – these are usually people lucky enough to have some sort of resources before hand like being left property and being mortgage free etc.
How about we massively reduce the working week? full time work is appalling in a world with such family and relationship fragmentation and little support beyond stupidly expensive ‘child care’ leaving your precious ones in the charge of minimum waged, burned out people slowly being killed by their own shit jobs.
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“How about we massively reduce the working week?”
There was time when i would have regarded such a proposal as utopian nonsense. But I’ve changed my mind after reading David Graeber’s Bullshit Jobs.
We need to re-think the whole concept of work. We could get the workweek down to twenty hours or even fifteen and not have any decrease in our standard of living.
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There are also proposals on the table, here for example https://neweconomics.org/2010/02/21-hours
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great post
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I like this analysis but also suggest a left not rooted in a proletarian movement aimed at overcoming capitalism is no left at all.
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I completely agree with you. in fact the terms “left” and “right” are really deceptive. “the left” as it exists today was designed and built for the purpose of crushing working class movements. it was the primary aim of the CIA to build a “non marxist left” to counter the very popular communist parties of the western hemisphere. that program was obviously very effective and now “left” doesn’t mean what it used to; it is not a clarifying, analytical term anymore but just the opposite; an obfuscation; hiding its real motives just like a spell. as a simple example; the democratic party in the usa cannot be “left” in the original sense of the word because they are against fundamental change and in favor of the status quo. this confusion already leads people to reject the “politicization” of anti or critical psychiatry movements. but they are wrong because the dictatorship of capital is at the heart of every major problem and injustice in today’s society. so the first task is to politicize this issue and define it correctly and openly.
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Relief from systemic maltreatment of people with mental health challenges will not be accomplished by fueling polarization between political parties. Focus on the humanity of those ill-served and injured by the Pharma-dominated paradigm of the managerial-health care system. We need a media blitz. Expose the conflicts of interest within the economic engine that provides jobs at all levels of employment to process patients who are injured by toxic medication and low standards of care. Educate the public on what a higher standard of care should be, which I would expect to be founded on Functional-Holistic medicine that by definition would also be trauma informed, inflammation informed, and focused on strengthening interpersonal relationships and access to naturally therapeutic settings. Stop the chaos plaguing this country which engenders mental illness. Political polarization is a diversion from the suffering happening RIGHT NOW and which cannot be resolved in a setting of political unrest and high crime.
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I view this exercise as radically over-simplistic. It comes across as a heavily biased overgeneralization that plants a flag of moral purity on one side and harsh pragmatism, blamed primarily on the evils of capitalism, on the other. This is not at all helpful or valid.
What is the point of such an exercise, really? Since the author does not acknowledge his apparent biases, it leaves the reader to imagine which presuppositions created his overgeneralizations.
My own presupposition is that persons on the Left and Right are, by and large, motivated primarily by a desire for truth in science and by an equally strong desire to help one’s fellow man in ways that honor mankind. It is entirely and lamentably dishonorable to presume anything but that.
Left and Right might have different motivations for this: humanism vs. theism, for example. That would be a much more interesting and valuable discussion, one I wish I would have just read.
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Good article!
I live in the USA. The left orā¦what remains of itā¦is generally not big into criticism of the over medicalization of life. Szasz is important for anyone who deals with the helping professions at all ever.
In the USA there was some resentment from the gop about so called crazy checks. Generally thoughā¦and I find this frighteningā¦it really does seem that republicans are throwing their weight behind psychiatry in its current form just as much as the so called progressive democrats who are joined in this unwavering support by the moderate democrats andā¦
I do see material from the more intellectual side of conservative Christianity but there again theyāve largely been shunned by the mega churches etc.
Rather dismal outlook for critical psychiatry here in Americaā¦
Unless one can pay out of pocketā¦
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My impression is that Big Pharma (the largest lobbying presence in the U.S. capitol, and by inference many other governments) has captured many elements of both major parties and political “sides.”
This is partly because they are aligned with other sectors of the materialistic sciences (centered around biology) that are pushing for an understanding of life (or living forms) that is non-spiritual in nature. The theory of evolution, neurological and genetic explanations for human behavior, and early successes of the use of medicines in controlling infection have all contributed to this ideological takeover.
The “Right” I suppose, will always be more concerned about the financial costs of bad medicine, and their remedies will tend to focus on simply reducing cost, not on innovations in the field of healing. The “Left” is more concerned about the social costs of bad medicine; the class and race disparities that seem to be part of the “old” system. But their remedies usually focus on moving healing practices into the realm of social justice and making health care more easily available to everyone.
I can only note that, while drugs have always been used in the healing arts, “modern” medicine is a fairly recent development and does not much resemble earlier practices in Europe or Africa or Asia or in indigenous regions. But none of those practices were that effective. In regions where Spirit was given a higher priority, they still had no real technology for placing Spirit in a position where it could successfully heal the body. These failures are one reason why “modern medicine” was embraced in the mid-1800s and onward.
It was not until the mid-1900s that workable methods for elevating the role of Spirit in healing were developed and demonstrated. By this time, “modern medicine” had become so politically powerful that it successfully demonized (in the eyes of most people) these legitimate advances. And that remains the situation to this day. Spirit, the supreme healer, remains buried beneath a pile of dogma and “science” so deep that most people are not even aware that they are standing on a heap of BS.
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I agree with you. if the “left” is the democratic party and the “right” are the republicans then those words are just empty signifiers because there is no disagreement on fundamental issues between those two parties. the two ruling parties are just two arms of the same body; and that body is the capital. but I disagree on the causes of the dominance of capital; it is not “spiritual” or even at its base ideological. ideology expresses concrete and material societal relations, not the other way around. the general conditions of today’s society was very accurately predicted by some political thinkers at the turn of the last century. by then it was called “monopoly capitalism” and that term still applies.
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At the turn of the 1800s or the 1900s? In the 1800s they still had philosophers that took Spirit seriously and were reading translated Eastern works like the Bhagavad Gita. Henry George, who inspired the original “monopoly” game, had connections to the world of spiritualism.
To study Spirit is also to study the creations of Spirit – this physical world – in all their good and evil aspects.
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Larry, research “Rockefeller medicine”, and the “Flexnar Report”….you’re welcome….
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I have already done this. Do you have a point to make?
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“My impression is that Big Pharma (the largest lobbying presence in the U.S. capitol, and by inference many other governments) has captured many elements of both major parties and political āsides.ā….”….
Your words, your “impression”…. And PhRMA ad spending on mass media & “TV ads” has far more to do with controlling the media narrative, than actually selling drugs. PhRMA is a key component in the Globalists’ depopulation and control agenda. Klaus Schwab’s “Great Reset” is another component of the centuries0old “Great Game”….
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Why wouldn’t control of the narrative lead to more drug sales? This link has been rather well-established.
The “globalist conspiracy” is intriguing and quite possibly real, but the activities of Big Pharma are totally in our face and can’t be missed.
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In context of the election of this year in the United States this is a small film over a multilayered film sub strata.
We have a candidate discussed several year earlier who is a convicted felon. He also has other issues and clearly is not in good health.
Regardless of politics I think these facts are importabt.
There has been a terrible time in our country for supportive services just the idea social services orgs call their heads CEOs says everything.
But also the history of colonization! One looks back and back and back and there it is over and over again. People taking over others lands abd sometimes languages
So MIA global is so important and it will be a long long effort to undoing unwind all the things that brought us to now.
I understand MiA is no political and it makes some sense.
We just have to keep going and highlighting all the work. It aināt easy .
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James Davies, so long as you continue to promote the delusional concept of a “left-right” in politics, you remain part of the problem….
Was this “left-right divide” discovered, invented, or created?….think carefully….
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I always appreciate taking apart unreal concepts, but left and right in politics does seem to stand as a descriptive term for two extremes, or two directions, within socially conditioned political consciousness, does it not? One of which promotes maximum greed, production, consumption and economic efficiency (i.e. seeing society as ‘the economy’ and seeing only this economy as important), and the other of which promotes social responsibility, which means looking after people and the environment, solving real social problems (i.e. seeing society as everything that is, as the people and their lives and their environment). But this to me is epiphenomena, and it is right to drill down beneath the unreal political divide. One can observe that this left and right polarity does not have political, social or discursive origins: it has something more to do with the state of consciousness. The right political tendency expresses the values of the socially conditioned ego, which is set for gain and exploitaton, for getting what it wants, while the left political tendency expresses the values of perception and understanding of what is, as it is, and in order to gain this perception and understanding of what is one has to care about what is, and care to understand what is. This is the only reason academics tend to be lefties (or students at least, as academics are just more ossified students who become like their parents). It is not that academics understand reality better and therefore become lefties – it’s because people who understand reality are more attracted to learning, and therefore become academics.
So it seems to me a reasonable point to ask for the factual basis for these artificial conceptual distinctions, but I would say a little hasty to deny any such basis, for such a basis can and should always be found, even in the most spurious conceptualizations. For example conspiracy theories have a basis in the ignorance and repressed and frustrated emotions and instincts of us all which makes us attracted to any kind of explanation that can reframe our frustrations and give them rational, discursive form – to make them socially ‘real’ in some way.
I apologise – I may have one of the most boring brains in the world. It’s so factual and painstakingly monotonous about what actually is that it has to compensate elsewhere. That’s why I’m a inside out multicoloured ballerina in a pink panther dancing costume, my breasts resting in an over the shoulder boulder holder, my arse attached to a roadside haulier. Being such makes up for the excruciatingly boring brain, as does the crack and smack and alcohol on tab, as does being a rat in a sack with a cat on acid and a dog on crack and smack, says my penguin with a bright pink bible and a red and brown leaflet for alcoholics anonymous.
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I’m not from America, but from what I’ve noticed from discussions online (and I may be wrong here), when it comes to Psychiatry:
From more liberally minded people (do-gooders), it becomes “Psychiatry is a scientific field. You are putting people at risk by speaking negatively about it and dissuading them from life-saving treatment”, “you are not a doctor” etc.
From more conservative people: “they’re f***king nutjobs, they need to be locked up”.
Both try to “put you in your place” in different ways.
Of course, people can’t be neatly delinated into “conservative” and “liberal”. There are all sorts of shades in between.
This post is meant to be mild satire. Don’t take it too seriously.
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I am not much concerned about the shadings between “liberal” and “conservative” as I am about all the people who exist outside of (or below in my model) these two points. The fact is that these two approaches to life are not extreme at all. The “extreme left,” per my model, exists way below these two points around a place called “covert hostility” – the level that most psychopaths operate on. Above them is the “extreme right” which operates more or less at the level of anger. They are the anti-social personalities and the sociopaths of life. Really, none of these people should be taken seriously in the arena of politics (or the healing arts) but many of them are.
People like this will always exist. Our willingness to take them seriously and give them a “seat at the table” so to speak is a big part of the problem. These people will do anything to destroy rational thought and discussion, and so are useless when it comes to finding rational solutions.
It is one argument, I suppose, against “majority rule,” and one reason why elites exist that think they should run things and that there needs to be some sort of entrance exam to be part of an elite. Unfortunately, we have no real protection against crazy people infiltrating the ruling elites and making life awful for everybody else.
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I call them the “GREG B.’s”, for “Global Ruling Elites, & Global Banksters”.
The WEF-Davos crowd. And, no, I don’t think your knowledge of them is anywhere near what YOU think it is. And, if I’m correctly deciphering your confusing narrative regarding your complex worldview of arbitrary and idiosyncratic human social categories, you must be a leftist-liberal-Democrat. Correct?….
there’s a HUGE point you’re missing. All these adults were raised by parents who themselves were abused in some way when THEY were children. By GRANDparents who were abused as children by the GREAT-Grandparents, and so on back into pre-history…. Most social dysfunction is/was a never-ending cycle of “repeat after me”…. Which is the title of a book you should read….
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There are also group cultural insults that are traumatic, such as the generation of Jews whose parents were in concentration camps. There are also lots of ways that parents and other adults can hurt their kids without realizing they are doing so. School was a great example for me – daily torture, but no one seemed to notice or care, I kept having to go back every day for 13 years. There are lots of ways people get hurt and traumatized as children.
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Satire, maybe, but TRUTHFUL, YES….
*NOTE: I intend this as a reply to “registeredforthissite”, above….
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Some supporters of Psychiatry are very manipulative. When you speak out against damages caused by mental health workers or their supporters or the maltreatment they dish out, they twist it into “you are putting people at risk by speaking negatively about Psychiatry”, rather than the fact that one is calling them out on their shit and that they don’t want other people to go through what they went through. Clever manipulative tactics.
Obviously, I’d want anyone in a crisis to get what is actually helpful to them and not be dished out what they are forced to accept as help.
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Life saving or life destroying. There are more effective and nuanced solutions than the lock, shock and drug biomedical reductionist culture would have you believe. It takes a life time of digging but it is all available to us today. The current systemic infrastructure will fall. It is just a matter of time. The evidence of itās failure is becoming overwhelming. Stay safe out there.
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I have heard some conservative Youtubers mocking Thomas Szasz, but they seemed to have no idea about what he actually taught. They claimed he had said that all behaviors were normal and should be tolerated no matter how bizarre or antisocial.
Szasz would counsel people to avoid obnoxious eccentrics who weren’t breaking the law instead of locking them up by force. If you can’t stand how Aunt Betty behaves in public just don’t go out with her. That’s the kind of advice Szasz gave.
He was a Libertarian. Neither right nor left.
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Haven’t seen you around in ages. Welcome back.
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