There are parts of Britain on the Couch that are fascinating, because the fundamental idea behind the book is so important. Oliver James argues that British society (and indeed, most of the western world) is unhappier now than it was fifty years ago, despite the obvious increase in prosperity. He gives a careful, complex analysis of the reasons for this perplexing phenomenon, and discusses at some length how we might increase our happiness. He is especially interested in the implications of Prozac and other SSRI medication, and is more ready than most to suggest that the large-scale use of Prozac could make life significantly better.
One of the most questionable and controversial ingredients in James' approach is evolutionary psychology. He seems to argue against some of the social changes that have so transformed our society over the last decades on the grounds that they go against human nature. This may lead readers to think of James as conservative, against social reform. But really he is a liberal who believes in fair treatment of all and strong government controls to protect society from the excesses of capitalism, while at same time he does argue that the destabilization of the family structure and the alienation of modern life has made people more depressed. Like most other social creatures, our happiness depends a great deal on our social status.
He starts the book with an example: Jim, 33, a successful lawyer with a steady girlfriend, has a crisis starting when he takes some of the drug Ecstacy. Although he had no previous history of mental disorder, he becomes unable to do anything, and Jim has great difficulty sleeping or eating for weeks, long after the drug has left his body. He starts taking antidepressants and he goes into psychotherapy, and he gets better. Indeed, he feels better than he did before his crisis. James argues that Jim was at higher risk for low serotonin levels because of life in the 1990s, because he was under a great deal of pressure to do well from an early age. He was always comparing himself with people who were more successful than himself, and believed that he was not doing well. Contemporary media, educational methods, and societal pressures had all reinforced this insecurity, with the result that Jim's peace of mind was surprisingly fragile.
The pressures on women have grown a great deal since the 1950s, according to James. They now compete with men in the workplace, and this they also are bombarded with images of beautiful women in the media make most women feel unconfident about their bodies and looks. The pressure on couples seems to have increased too, since the divorce rate has skyrocketed. Mental illness is diagnosed far more often now. In the US, one survey found that people born between 1945 and 1955 were between three and ten times more likely to suffer major depression than people born between 1905 and 1914. Suicide rates among young men have trebled in Britain since 1970. Violence against individual persons has increased fivefold since 1950. Drug and alcohol use has increased in most countries, especially among young people.
One might question his claim that there is more overall unhappiness. For instance, one might argue that the definitions of mental illness have become more liberal over the years, and so the increase in numbers of diagnosis of mental illness don't reflect a real change, but simply a change in the ways we measure illness. Similarly, there's a a good deal of flexibility in which deaths are counted as suicides: it might be that coroners are these days more likely to count a death as a suicide because there is less stigma associated with it, while before it would be often counted as an accidental death.
Alternatively, one might accept the statistics, but nevertheless one could argue that although there is more unhappiness and anxiety, there is also more happiness and fulfillment. That is to say, one might argue that society is more free these days, and so while some people have worse lives, other people have better lives. James has not given any evidence that the overall level of happiness has decreased since 1950.
Finally, one might say that really the idea of comparing the happiness of one generation with another's is so problematic for methodological and conceptual reasons that it makes no sense, and the more different the societies one trying to compare, the less viable is the comparison. Thus to ask whether society today is happier than society one thousand years ago is so riddled with problems that no meaningful answer can be given. Similarly, to compare happiness in the US with that in Papua New Guinea makes no sense -- not that James tries to make anthropological comparisons, but the kinds of problems that exist here also exist in historical comparisons. These are issues that a truly thorough approach to this topic would have to address, and James' approach is rather too unquestioning.
Similarly, his talk of a "low serotonin" society smacks of journalistic simplification. James himself is well aware that our knowledge of the brain and the function of serotonin in it is in fact very cloudy. It is true that low serotonin levels have been associated with low social status in some societies of monkeys and have been associated with dysfunction in mice and rats, and that low serotonin has been found in people post mortem who have killed themselves. But there's no proof that serotonin is the most important neurotransmitter in these phenomena or that low serotonin is directly responsible for depression. So really all James is saying is that our society has higher rates of depression and higher rates of other social and mental problems.
Having said that, his argument that there is more depression, and anxiety, and personal violence than there was fifty years ago is fairly plausible. These changes can't be explained by genetics, since the genetic pool has not changed significantly in this time period. So James looks to social changes to explain these troubling statistics. These include the rise in the influence of the media, the increasing divorce rate, and the move of women into the workplace. Focus on these aspects of society is normally the mark of conservative social critics, and indeed there are times when James is reminiscent of some of the sociobiologists who argue that social roles are determined by biology. But for the most part his writing is sophisticated, and his intuitions are more liberal than conservative.
James considers the social aspects of treating mental illness, going over the different options, and he is especially interested in the implications of Prozac and other SSRI drugs. While he does not think that they are a panacea he does think that they may be the best available solution for people with mental disorders and he is even ready to consider the wide scale prescription of medication in society. Psychotherapy and more profound modifications of the way we run society might be better solutions, but they are either too expensive or else they are politically unfeasible. James argues that the view that drugs are unnatural and therefore problematic is a form of calvinism, and he is not particularly sympathetic to the view.
Britain On The Couch covers important and wide-ranging topics. It's not a particularly compelling ready -- for a variety of reasons, I kept on picking it up and putting it down and it took me two years to finish reading the whole book. It is also largely about Britain, and although the ideas would apply to some extent to the US and other western countries, there enough references to British life that non-British people might often get confused. Still, it's written for a general readership and the argument is distinctive and thoughtful enough for it to be worth investigating.