Dr James Davies (PhD) 💭
@JDaviesPhD
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Dad - Husband - Writer - Assoc Professor of Medical Anthropology & Psychology (Ph.D @UniofOxford). Practicing Psychotherapist (UKCP). Previous NHS. @appgpdd
Uni of Roehampton, London
Joined May 2019
Hi folks, I'm very proud to say that my book, Sedated, is released today! I've done everything within my power to write a book worthy of your time - one that illuminates via interviews, stories & research why our mental health sector is broken & how we may put it right again. 1/5
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During a very dark period, what was the best thing you ever did for your mental health?.
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During a very dark period, what was the best thing you ever did for your mental health?.
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'Resilience' is a sneaky neoliberal trope. It frames, as a psychological virtue, painful endurance of circumstances from which others benefit at your expense.
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What helped you through a period of severe mental/emotional distress, and was not a drug, a therapist, or an act of consumption?.
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What helped you through a period of severe mental/emotional distress, and was not a drug, a therapist, or an act of consumption?.
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My most used psych-diagnoses would be:. Social suffering.Situational distress.Sane reaction (to e.g. poverty, abuse, overwork, inequality).Complex trauma .Meaninglessness.Existential dread [of varying kinds].Loneliness.Unmet needs.Just surviving syndrome. Shame they don't exist.
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‘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’ #Sedated 👇
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My most used psych-diagnoses would be:. Social suffering.Situational distress.Sane reaction (to e.g. poverty, abuse, overwork, inequality).Complex trauma.Meaninglessness.Existential dread [of varying kinds].Loneliness.Unmet needs.Just surviving syndrome. Shame they don't exist.
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"Many psychiatrists & psychologists refuse to entertain the idea that society as a whole may be lacking in sanity. They hold that the problem of mental health [is to do with]. ‘unadjusted’ individuals, and not [with] a possible unadjustment of the culture itself.”. - Erich Fromm.
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The greatest threats to mental health:. poverty.inequality.social injustice.abuse.trauma.discrimination (of all kinds).neoliberalism.poor relationships, diet, exercise.social exclusion.materialism.prejudice.loneliness.iatrogenesis.individualism.meaninglessness. What did I miss?.
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Since the 1980s we've been told that emotional suffering is rooted in untreated 'mental disorders' rather than in unmet social/psychological/relational needs. In no other period has this historically outlying belief so dominated, nor has mental health disability so increased.
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How often it is that a young person’s pain (self-harm; eating problems) is a desperate attack, via the self, on a dysfunctional family, idea, school or wider system; a plea for systemic change. But we rarely see it like that - instead we pathologise them & treat *their* disorder.
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An old therapist friend once told me that suicide isn't born of the need to end one’s life, but to end/reform the particular life & circumstances that one is now living. I've reminded many people of this crucial distinction when in the depths of despair - it's been very helpful.
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Instead of that psych drug, perhaps what you really needed was time off work, a person to care & listen, a quiet place to retreat, reflect, reassess & repair. Perhaps you needed us to treat you as worthy of a kinder world; of a social & human rather than a chemical response.
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Instead of talking about 'mental disorder' epidemics, how about we discuss the epidemics of loneliness, inequality, work dissatisfaction, child neglect, debt-stress, insecure or over work, domestic abuse, inflation, household poverty & various addictions (illicit & prescribed). ?.
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Labelling emotional distress as 'dysfunctional' makes no real psychological sense. All distress is functional if you look deep enough. At the very least it's a protest against harmful circumstances and/or unmet needs. It demands care, understanding & change - not pathologisation.
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When I worked in the NHS our unit offered psychotherapy for up to 2 years. Amazing place, but now sadly gone. Instead, today you'd be lucky to get 2-6 sessions of IAPT 'therapy'. Germany has a national long-term therapy programme, please 'like' or RT if you agree so should we.
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Can we at least agree on this: that as a society we need to move away from a mental health system that privileges pathologising & medicating our emotional pain, towards one that foregrounds psycho-social-relational understandings & interventions in the management of distress.
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We ask people to bravely seek help for their mental distress. But what awaits them when they do? Most get 7mins with a GP & a prescription. Some, a couple of IAPT 'therapy' sessions after a long wait, a few a psych-referral. Let’s be honest about what accessing ‘care’ looks like.
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Last year in England 7.4 million people were prescribed antidepressants & only 1 million psychotherapy. Yet, research shows that most people who consult a doctor for emotional help would prefer therapy over a prescription. The imbalance isn't in our brains it's in our provision.
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How often it is that a young person’s pain (self-harm; eating problems) is a violent attack, via the self, on a dysfunctional family, school or wider system; a violent call for systemic change. But we rarely see it like that - instead we pathologise them & treat *their* disorder.
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The rising tide of antidepressants prescriptions in England:. 2011 - 47.3 million.2012 - 50.1.2013 - 53.3.2014 - 57.1.2015 - 61.0.2016 - 64.7.2017 - 67.5.2018 - 70.9.2019 - 74.8.2020 - 80.1.2021 - 83.4. At this rate nearly a 1/4 of adults will be prescribed ADs by 2030. Thoughts?.
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The capacity to sit with another’s pain is not a therapeutic ‘skill’ or ‘technique’ but an achievement of the personality. Good therapy is facilitated by the qualities of self, not the performance of manualised tricks, tools & strategies. What do you think?.
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“Our mental health sector has become 'the new opium of the people' by working to pathologise the social suffering that would otherwise galvanise people to political action - spreading an ideological sedative powerful enough to disable the human impulse for social reform.”
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Finally, the new WHO guidelines recommend psychotherapy over antidepressants for first line treatment of depression. Finally the tide is turning. Do not underestimate the significance of this.
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"Efforts to prevent depression [in children] might ultimately need to demand less of teachers and kids, and focus more on poverty, violence, homelessness, food insecurity & other structural problems that affect children’s mental health".
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The NHS is over-burdened because we, as a society, care so little about addressing the social determinants of distress - inequality, poverty, marginalisation, lax opportunity, poor work etc. No single social institution can carry the burden of such wider systemic negligence.
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What is the most unhelpful thing a mental health professional ever said to you or recommended?.
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To demedicalise distress is not to delegitimise distress. One can honor, respect and care for profound suffering without labeling it as illness, pathology or disorder.
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What helped you through a period of severe mental/emotional distress, and was not a drug, a therapist, or an act of consumption?.
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Instead of talking about 'mental disorder' epidemics, how about we discuss the epidemics of loneliness, inequality, work dissatisfaction, child neglect, debt-stress, insecure or over work, domestic abuse, inflation, household poverty & various addictions (illicit & prescribed). ?.
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When I worked in the NHS our unit offered psychotherapy for up to 2 years. Amazing place, but now sadly gone. Instead, today you'd be lucky to get 2-6 sessions of IAPT 'therapy'. Germany has a national long-term therapy programme, please 'like' if you agree so should we.
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Educating young people to be 'resilient' to the effects of deep social/structural injustices & inequalities is literally becoming a flagship neoliberal policy - rendering the next generation tolerant of a rigged economy that acts against their health, flourishing & happiness.
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So much misery in the world is caused by people staying in jobs or entire professions that harm them, but who can't even imagine a way out. If you got out, how did you do it?.
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The concept of 'mental disorder' is, in essence, a cultural artifact. Many cultures do not frame distress in this way, and there is little in our science or outcomes to suggest that our framing is superior.
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If you are feeling down, inordinately sad, & have lost all interest in things, you aren't suffering the 'symptoms of major depression'. You are rather feeling down, inordinately sad, & have lost all interest in things.
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My new book. Released June 3rd, 2021. A first peek at the cover.
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Labeling emotional distress as 'dysfunctional' makes no real psychological sense. All distress is functional if you look deep enough. At the very least it's a protest against harmful circumstances and/or unmet needs. It demands care, understanding & change - not pathologisation.
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Instead of that psych drug, perhaps what you really needed was time off work, a person to care & listen, a quiet place to retreat, reflect, reassess & repair. Perhaps you needed us to treat you as worthy of a kinder world; of a social & human rather than a chemical response.
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Each time you mock or bully someone on Twitter you lose a measure of credibility. After a while, even to your supporters, you'll become, at best, a guilty pleasure, & at worst, a liability. One day you may learn, through experience, that the harm you inflict is against yourself.
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"Maybe the widespread anxiety and depression, along with the near record rate of suicide, should not be seen as personal disorders. Maybe they should be seen – in many cases – as rational responses to a society that’s becoming ever more disordered".
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If we prescribed relational support, walks, exercise, animal contact, rest, nutrition, insightful films/literature, basic financial support, community activity, rather than only psych-drugs, I venture our nation's woeful mental health outcomes would finally significantly improve.
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More funding for mental health? Be careful. Our medicalised system has had over 40 years to prove itself. By most measures it's failed: mental health worsening, prescriptions vaulting, outcomes flatlining, morale tumbling. If we are going to fund, let's not fund more the same.
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One of the greatest findings of 20th century anthropology is that social structures shape psychological structures, and one of the greatest failings of modern psychology is to have almost entirely ignored this.
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There is no such thing as the “neurotypical.” Literally 85% of the global population is not typically the same. 'Typicality' vs 'divergence' is a false binary; as simplistic and as crude as the splitting of people into good/bad or civilised/uncivilised. We must do better.
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Can we stop medicalising student anxiety as a ‘mental health problem’. I'd be anxious if I were about to enter such an inhospitable world: with flatlining wages, high inflation & job insecurity, unreachable house prices, careers for life gone, & massive students debt to repay.
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The self-care or self-help movement flourishes on the myth that atomised isolated individuals are able to transform themselves in the absence of social, material and relational supports. And when when the project inevitably fails, it pronounces you only have yourself to blame. .
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To be told you are suffering from an internal mental dysfunction/disorder, when in fact you are suffering from unmet psycho-social &/or relational needs, is to potentially open yourself up to being worryingly misled, maddeningly misunderstood & harmfully mismanaged.
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If we prescribed relational support, walks, exercise, animal contact, rest, nutrition, insightful films/literature, basic financial support, community activity, rather than only psych-drugs, I venture our nation's woeful mental health outcomes would at last significantly improve.
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The psychological virtues of the neoliberal era:.'Resilience' is a sneaky neoliberal trope. It frames, as a psychological virtue, painful endurance of circumstances from which others benefit at your expense.
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The capacity to sit with another’s pain is not a therapeutic ‘skill’ or ‘technique’ but an achievement of the personality. Good therapy is facilitated by the qualities of self, not the performance of manualised tricks, tools & strategies. What do you think?.
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What *we* consider to be 'neurotypical' behaviour isn't universally 'typical', as every culture has its own idea of what 'typical' behaviour is. In this sense, 'typicality' is not a product of neurological design, but of adapting to a culturally specific form of socialisation.
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To demedicalise distress is not to delegitimise distress. One can honor, respect and care for profound suffering without labeling it as illness, pathology or disorder.
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Nearly a 1/4 of our population was prescribed a psych-drug last year. Yet the majority weren't suffering from biologically discernible 'mental illnesses' but from comprehensible human reactions to serious socio/psycho/relational problems - issues the drugs are powerless to treat.
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"Mental Illness Is Not in Your Head - Decades of biological research haven’t improved diagnosis or treatment. We should look to society, not to the brain".
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The self care or self help movement flourishes on the myth that the heroic, atomised, isolated individual is able to transform themselves in the absence of solid social, material & relational supports. It also contends that should you fail you were obviously not committed enough.
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'Patients' don't 'have' depression. People in pain & distress get 'diagnosed' with 'depression' by mental health professionals. These are very different things.
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Psych-diagnosis is what we call in anthropology an 'initiation ritual' into a very different social status: one where new authorities & practices can now exert power where they had no jurisdiction before, & where a new story of you is written to legitimise this arrangement.
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Can we stop medicalising student anxiety as a ‘mental health problem’. I'd be anxious if I were about to enter such an inhospitable world: with flat-lining wages, high inflation & job insecurity, unreachable house prices, careers for life gone, & massive students debt to repay.
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'Patients' don't 'have' depression. People in pain & distress get 'diagnosed' with 'depression' by mental health professionals. These are very different things.
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Educating young people to be 'resilient' to the effects of deep social/structural injustices & inequalities is literally becoming a flagship neoliberal policy - rendering the next generation tolerant of a rigged economy that acts against their health, flourishing & happiness.
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An old therapist friend once told me that suicide isn't born of the need to end one’s life, but to end/reform the particular life & circumstances that one is now living. I've reminded many people of this crucial distinction when in the depths of despair - it's been very helpful.
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"A psychiatric diagnosis. contains a narrative about what progress or recovery should look like. dictating a person’s sense of self. intruding so deeply into their identity that it may be difficult to imagine an alternative way of being".
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Women are twice as likely than men to be psych-diagnosed & medicated. The establishment rationale: "women are more likely to step forward for care." No. Women's suffering is less socially tolerated; more likely to be pathologised as indicating an individual than a social problem.
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More funding for mental health? Be careful. Our medicalised system has had over 40 years to prove itself. By most measures it's failed: mental health worsening, prescriptions vaulting, outcomes flatlining, morale tumbling. If we are going to fund, let's not fund more the same.
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More funding for mental health? Be careful. Our medicalised system has had over 40 years to prove itself. By most measures it's failed: mental health worsening, prescriptions vaulting, outcomes flatlining, morale tumbling. If we are going to fund, let's not fund more the same.
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Lot's of people on Twitter & in the media have been minimising as a 'potential side-effect' the emotional blunting caused by antidepressants. To be clear, when emotional blunting occurs in 40-60% of users, it's hardly a 'side effect'. It's more likely the primary mode of action.
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The mental health interventions preferred since the 1980s are ones that have pathologised, depoliticised & commodified our emotional distress – robbing it of its capacity to illuminate social ills, galvanise social action & facilitate lasting/meaningful personal & social change.
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Educating young people to be 'resilient' to the effects of deep social/structural injustices & inequalities is literally becoming a flagship neoliberal policy - rendering the next generation tolerant of a rigged economy that acts against their health, flourishing & happiness.
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Without a psych-diagnosis, access to support is denied. The neoliberal state thus demands you accept yourself as dysfunctional before it will 'help', capturing your suffering in an ideological move where the fault is located in you rather than in your environment or unmet needs.
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If there were one book you'd recommend that every trainee therapist read, what would that book be?.
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Psychiatry & pharma want you to believe the debate is about ‘pro-meds’ vs ‘anti-meds’. It’s not. It's about how to curtail over-prescribing & enable more psycho-social interventions; how to redress iatrogenic harm & correct pro-pill misinformation. That's what the debate is about.
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We ask people to bravely reveal their m distress & seek help. But what awaits them when they do? Most get 7mins with a GP & a prescription. Some, a couple of IAPT 'therapy' sessions after a long wait, a few a psych-referral. We must be honest about what being brave will win you.
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“Women are disproportionately diagnosed with mental problems. But what if the crisis is one not of chemical imbalances, but power imbalances?”
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All the psychiatrists quoted in this article (apart from J. Moncrieff), have financial ties to the pharma industry. One is even a part-time employee of Lundbeck. Yet none of these financial interests are declared in this article. Due diligence @guardian?.
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"While most medical experts consider depression as a universal, neurobiological disease. anthropologists instead ask why the illness known in psychiatry as ‘depression’ appears to have been extremely rare in much of the world until very recently". 👇.
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To be told you are suffering from an internal mental dysfunction/disorder, when in fact you are suffering from unmet psycho-social &/or relational needs, is to potentially open yourself up to being worryingly misled, maddeningly misunderstood & harmfully mismanaged.
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The fact that women are almost twice as likely to be psychiatrically diagnosed and medicated than men, says far more about our society than about women. The over-pathologisation of womanhood is a pernicious force. I'm very much looking forward to reading @DrJessTaylor's book.
I am acutely aware that the arguments I will present in my new book will be challenging, controversial and new to many readers. I know that whenever I discuss pathologisation and misogyny in mental health publicly, they invoke mixed responses and feelings in thousands of people.
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Anthropologists have noted how many indigenous groups use instances of individual distress as occasions to inspect what's wrong with the social group; the individual embodies the unworked-through tensions & pains of the collective. Via this social ritual the individual is healed.
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'What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props & understandings are rapidly disappearing. 1/4.
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One of neoliberalism's most cunning successes has been its ability to convince an entire generation that the route to a happier life comes via the individualistic hunt for new personal identity, rather than a collectivist fight for structural economic reform.
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Many MH professionals will never demedicalise their language. Not because words like 'illness' 'disorder' 'psychopathology' accurately capture the nature of suffering, but because such symbols endow their practices with an aura of medical status & credibility. Language is power.
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"Our mental health services have not evolved to reflect what we know about mental health. They have maintained the vice-grip of a medical model & are designed to protect the privilege & interests of one profession at the expense of people’s mental health".
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To demedicalise distress is not to delegitimise distress. One can honor, respect and care for profound suffering without labelling it as illness, pathology or disorder.
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Abuse, poverty, trauma, loss, hardship, inequality, toxic relationships. etc., are all real. Chemical imbalances are not.
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Abuse, poverty, discrimination, loss, hardship, inequality, toxic relationships, meaningless work etc. are all real. Chemical imbalances are not.
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A new study finds that psychiatrists who worked on DSM-5 received $14M in undisclosed funding from the pharmaceutical industry; the very industry that has profited enormously from DSM's over-medicalisation of everyday life.
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The obtuse phrase ‘let’s de-stigmatise psychiatric disorder’ actually means: ‘let’s normalise the psychiatric framing of emotional pain'- let's pathologise, dehumanise & depoliticise how we understand & manage psycho-social distress. The phrase is a device of ideological capture.
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The chemical imbalance myth mislead an entire generation as to the origins of their emotional pain. It distracted them from its psychosocial drivers & wooed so many onto meds as the primary & most viable solution. But no one now wants to take responsibility for this. Who should?.
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Let's not call for more resilience, diagnoses, drugs, medicalisation & neurofication to address escalating rates of poor mental health, let's call for new social policy to tackle its social determinants & properly fund demedicalised psycho-social support. That's it in a nutshell.
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"Antidepressants can cause ‘emotional blunting’, study shows", with another suggesting that blunting may occur in 40-60% of people taking the drug.
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‘Neurodiversity advocates ignore the harsh realities of severe autism. They’ve done a good job of hijacking the message & monopolising the discourse. controlling the narrative so tightly that people like my sons will have no choice in the world.'.
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"Australia has become the first country in the world to legalise the use of psychedelics. Approved psychiatrists can now prescribe MDMA to those suffering post-traumatic stress disorder and magic mushrooms for some types of depression". - Thoughts?.
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If you’ve had a positive experience of psychotherapy/counselling, what do you consider to have been the single most important factor making it so?.
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I can't get an NHS dental appointment anywhere in South West London. Only private appointments. Why is there no public discussion on how dentistry has now been effectively privatised.
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TikTok is an oddly apolitical space, full of young people framing their distress in clinical/diagnostic rather than political ways. Is TikTok fuelling or just simply reflecting the growing cultural propensity to depoliticise societal problems as personal issues?.
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“Acute mental health services are becoming overwhelmed by referrals for people with "normal negative human emotions" who may actually be harmed by treatment, a leading psychiatrist has said.”
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The rise of antidepressant prescriptions in England:. 2011 - 47.3 million.2012 - 50.1.2013 - 53.3.2014 - 57.1.2015 - 61.0.2016 - 64.7.2017 - 67.5.2018 - 70.9.2019 - 74.8.2020 - 80.1.2021 - 83.4.2022 - 85.5. At this rate a 1/4 of adults will be prescribed ADs by 2030. Thoughts?.
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