The Sedated Society: The Causes and Harms of Our Psychiatric Drug Epidemic is an edited volume by anthropologist and psychotherapist James Davies (Reader at the University of Roehampton, London). In The Sedated Society, Davies, co-founder of the Council for Evidence-Based Psychiatry (CEP), brings together nine "critically-minded" writers within the area of psychopharmacology. Readers familiar with the critical psychiatry literature will be familiar with names such as Peter Breggin, Peter Gøtzsche, Joanna Moncrieff, and Robert Whitaker. Other contributors include psychologist Peter Kinderman, psychiatrist Sami Timimi, and CEP co-founder Luke Montagu. Davies and his fellow contributors endeavor to provide an evidence-based critique of what they see as two fundamental problems within current mental health practice: The (1) Overprescription of and (2) Harms associated with psychiatric medications. In this review, I will describe each section of the book, provide some general commentary, and give an overall impression of the book's value.
The book's eleven chapters are unofficially divided into three sections. After a brief introductory chapter by Davies, Section One comprises Chapters 2-4, detailing problems in psychiatric drug trial methodology, the evidence-base for psychiatric drug use, and the historical antecedents and contributory factors towards creation of the medical model of psychiatric drug action. The strongest and most forceful of these chapters is Chapter 2 by Peter Gøtzsche. His conclusion that, "…we need only 2% of the psychotropic drugs we currently use" (p. 44) comes off to the casual reader as surprising, but his arguments about clinical trial unblinding, underreporting of drug harms, and pharmaceutical misbehavior are well-argued. Section Two comprises Chapters 5-7 and describes the iatrogenic harms of psychiatric drugs, providing the perspective of both a user (Luke Montagu, Chapter 5) and a psychiatrist (Peter Breggin, Chapter 6). These chapters highlight the harms, whether intentional or not, that can occur with psychiatric medications (particularly antidepressant and antipsychotics) and detail how these adverse effects can be misrepresented as being the result of a purported underlying psychiatric condition. The section concludes with a chapter by writer Robert Whitaker, who provides a narrative of how various "economies of influence" have driven psychiatry to exaggerate claims of diagnostic reliability/validity and therapeutic efficacy. This chapter is well-written, but is oddly situated with the other two in the section. Section Three comprises Chapters 8-10, which focuses the proliferation of the Western model of mental health around the world. Editor James Davies contributes a chapter on what he argues is a key driving force for this trend: neoliberalism. Chapters by China Mills and Stefan Ecks describe the proliferation of prioritization of psychiatric drugs in places like Southeast Asia. The final chapter by Peter Kinderman (Chapter 11) stands alone and offers a manifesto for changing current practice, including the structure of the current mental health system.
The Sedated Society is, professedly, aimed at three groups of readers: 1) Those already in agreement with the book's theses; 2) Those taking the "middle ground" in the debate about the use and utility of psychopharmaceuticals; and 3) The mainstream clinician, researcher, service-user, etc. who finds undertreatment to be a more pressing concern than overprescription or purported drug harms (pp. 17-18). Of these I think the book is least successful in convincing its mainstream readers. While most chapters are clear and well-written and referenced, the arguments are often presented in a polemic-tone, that can be off-putting to those unfamiliar with the position. For example, Chapter 6 begins with Breggin's declaration that the antipsychotics are, "…among the most toxic and deadly medicines in use today"…which "…injure every organ of the body" (p. 124). Irrespective of the validity of the arguments supporting this claim, the position is immediately off-putting to anyone who has ever found a beneficial use from antipsychotic drugs. Facts are facts and are not dependent on one's position toward them, however, if your aim is to inform, convince, or invoke change, a more measured approach may yield better results. This is not to say that such extreme positions cannot be argued for, but rather that the manner in which they are argued for can be made less jarring for those still "on the fence". Similarly, in Chapter 11 Peter Kinderman offers a radical, utopian-flavored, call to reorganize the mental health system, suggests dramatic changes, but doesn't always describe means for achieving those solutions (e.g. he writes "…in a fair society…we would ensure that everyone had a meaningful job or role in society…" [p. 299], with no clear political, social or economic description of how such a goal would be achieved).
With those comments in mind, I can recommend The Sedated Society as a stimulating case for the existence of overprescription and for the acknowledgment of the various harms associated with psychiatric medications. Some points may be overstated, some conclusions invalid, but the volume presents a fairly clear argument for the rethinking of how we provide mental health care. Opponents to the book's theses will want to carefully consider the arguments presented. Supports will find new and engaging lines of argument and proposals (e.g. Peter Kinderman's call to do away with psychiatric diagnoses [p. 294] or Davies' argument for the role of neoliberalism in medicalization and pharmaceuticalization of society [pp. 190-197]). Mental health clinicians, service-users, and researchers of all stripes will find the volume of interest. Those new to the debates will find each chapter to be an accessible entry point for each author's more popular critical works (e.g. Davies' 2013 Cracked: Why Psychiatry is Doing More Harm Than Good; Gøtzsche's 2015 Deadly Psychiatry and Organized Denial; Moncrieff's 2008 The Myth of the Chemical Cure).
© 2018 Daniel J. Dunleavy
Daniel J. Dunleavy, M.S.W., Doctoral Candidate; Florida State University, College of Social Work