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Right-Wing or Left-Wing: Who Really Owns the Critique of Over-Medicalisation?
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 ‘mental disorder’ to capture experiences that weren’t 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 ‘The Mental Health Con is Bankrupting Britain’, 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 ‘psychiatric’ 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 solutions—not 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:
“The current ruling ontology denies any possibility of a social causation of mental illness. Considering mental illness an individual chemico-biological problem has enormous benefits for capitalism. First, it reinforces Capital’s 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 causation…. 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.”
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 quo—enabling and abetting it—a 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 ‘Szazians’ (right-wing), create skewed narratives about who the critics ‘really are’, 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 are—something I have attempted to do, at least cursorily, above.
A Brief Reading List of Left-Wing Critiques of the Psychiatric System
Cohen, B.M.Z. (2016). Psychiatric Hegemony: A Marxist Theory of Mental Illness. London: Palgrave Macmillan.
Cromby, J. & Johnstone, L (2024) Are we all neurodivergent nowadays? Mad in America: https://www.madintheuk.com/2024/07/neurodiversity/
Davies, J. (2021) Sedated: why capitalism is causing our mental health crisis. London: Atlantic Books.
Davies, J. Guy, A. Montagu, L. Stacey, S. Chiva Giurca, B. Johnstone, L. (2024) ‘Shifting the Balance towards Social Interventions: A Call for an Overhaul of the Mental Health System’ Beyond Pills APPG Report.
Esposito, Luigi. & Perez, Fernando. M (2014). ‘Neoliberalism and the Commodification of Mental Health’. Humanity & Society, 38 (4): 414-442.
Fisher, M (2009). Capitalist Realism: is there no alternative? London: Zero Books.
James, O. (2014) The Selfish Capitalism: the origins of affluenza. London: Vermillion
Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.
Kinderman P (2019) A Manifesto for Mental Health: Why We Need a Revolution in Mental Health Care. London: Palgrave.
Moncrieff, J. (2008) Neoliberalism and biopsychiatry: a marriage of convenience. In: Carl I. Cohen & Sami Timimi (eds.), Liberatory Psychiatry: philosophy, politics and mental health. New York: Cambridge University Press. pp. 235–55 (2008)
Pûras, D. Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health UN, 2017