introduction

Part 1: The New Opium

Chapter 1: Economic Prelude
Chapter 2: A New Culture of Debt and Drugs
Chapter 3: New Discontents Born of Modern Labor
Chapter 4: New Psychotherapy for Returning to Work
Chapter 5: New Causes of Unemployment
Chapter 6: Education and the Rise of New Managerialism

Part 2: How We Got Here

Chapter 7: Deregulation of so-called chemical treatments
Chapter 8: No More Materialism
Chapter 9: Dehumanizing Productivity
Chapter 10: Blame Only Yourself
Chapter 11: Social Determinants of Pain

conclusion

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Translator's Note
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When suffering becomes a commodity, the possibility of solidarity disappears.
- Why is our mental health not improving but rather worsening?
- Was it really a progressive change that mental pain became a target of treatment?

Mental illnesses such as 'depression' and 'ADHD' have become social problems that are no longer unfamiliar.
About one million people are treated for depression each year, and prescriptions for ADHD medication, known as "study aids," have more than tripled in the past five years.
However, despite various medications, the number of patients suffering from mental illness continues to increase.
Why is our mental health getting worse instead of better?

In his book, “Selling Mental Illness,” British medical anthropologist James Davis diagnoses that the fundamental cause of the mental health crisis is a massive shift in the “culture of understanding pain.”
When mental illness is viewed solely as a problem of an individual's brain that must be treated with medication, the context surrounding mental suffering disappears from view.
Despite the fact that unemployment, competitive education, and a materialistic worldview are the social causes of suffering, the number of people with mental illness increases in a society that individualizes, medicalizes, and commodifies suffering, while the possibility of political solidarity through suffering actually diminishes.

The author not only visits clinical counseling sites and presents statistical analyses, but also explores the relationship between neoliberal society and mental illness through interviews with politicians, psychiatrists, and anthropologists.
This book shows how the suffering caused by our society's failures has been defined as mental illness, and how an individualistic view of mental illness has been promoted by government and big business, and why this is inappropriate and dangerous.
Furthermore, we discuss how we can overcome the neoliberal society and therapeutic worldview that have transformed the way we think about pain.

Why is our mental health getting worse?

The scope of mental illness has expanded aggressively over the past several decades.
Accordingly, 'medicalization', the process by which emotions that were not previously understood as diseases are now understood as diseases, has also progressed rapidly.
This process has resulted in much of the mental distress we experience on a daily basis being unfairly medicalized, pathologized, and medicated.
Lack of concentration at school, poor performance at work—these are just a few of the many afflictions that have recently been medically reclassified as symptoms of mental illness.

As the author points out in Chapter 2, “A New Culture Spreading Debt and Drugs,” until the 1960s and 1970s, depression was considered a disease that affected only a small number of people and that would naturally resolve and improve without any special treatment.
However, especially with the development of SSRI antidepressants, depression began to be understood as a disease similar to a 'cold of the mind', that is, a biological disease located within an individual and therefore a disease that anyone can contract. As this understanding spread, the scope of 'depressed patients' requiring treatment also rapidly expanded.


However, despite the growing discourse on psychology and the increasing number of people taking psychiatric medication, the number of patients with mental illness in our society has continued to increase.
This primarily relates to the profit-seeking behavior of the pharmaceutical industry and the psychiatric community, which have aggressively expanded the scope of mental illness despite the lack of any significant scientific basis.
However, the book's main argument is that this phenomenon is also deeply connected to a 'neoliberal society' that seeks to maintain individual productivity by advocating individualistic and marketized solutions that isolate individuals from society.

Indeed, the mental health industry has "depoliticized" suffering by conceptualizing it as a brain disease rather than a response to a painful social situation in which the individual finds themselves; "pathologized" suffering by attributing it to a defect in the brain or genes, even when there is no credible evidence; and "commodified" suffering by turning it into a problem that can be solved with more appropriate medication.
The problem is that this perspective not only encourages drug use in people who don't necessarily need it, but also obscures attention from social factors like poverty, discrimination, and loneliness.
Moreover, empirical research has revealed that excessive reliance on drugs causes more harm and side effects than benefits in the long term (see Chapter 2).

The author empirically demonstrates these issues through his own experiences as a counselor and cases from other clinical settings. He not only presents scientific research and statistical data, but also exposes the unscientific and harmful nature of the psychiatric perspective that thoroughly frames mental suffering as a problem of the individual's brain through interviews with experts.
Furthermore, we explore the socio-cultural and economic reasons why this therapeutic perspective has received widespread societal support despite its lack of practical effectiveness.

The emergence of a society that depoliticizes and individualizes suffering

One of the defining characteristics of neoliberalism is that individuals themselves become commodities, and individuals are constantly required to develop the ability and image to adapt to the modern economy in the name of realizing their true selves.
This is precisely the phenomenon that the author captures in Chapter 3, “New Discontents Born of Modern Labor.”
The new capitalism translates the demands for autonomy—self-realization, creativity, individuality—that the author explores in Chapter 9, “Dehumanizing Productivity,” into demands for the practice of neoliberal “freedom,” requiring people to develop the qualities necessary for labor.
In this system, human emotions are just another object of intimate self-monitoring and enhancement, and psychological pain is nothing more than something to be managed efficiently and economically.

In this respect, it is quite significant that mental illness is often constructed as the opposite of the human image that neoliberal society demands: a tireless, always active, productive, and positive human image.
As the author points out in Chapter 9, “Dehumanizing Productivity,” the Global Functioning Scale of the Diagnostic and Statistical Manual of Mental Disorders (DSM) conceptualizes low work productivity and job performance as key features of mental disorders.
Inability to sustain attention on a task, difficulty making decisions, fatigue, and psychomotor retardation are sometimes defined as the main features of a depressive episode.

In this way, in the modern psychiatric and psychological worldview, only individual pathology exists, and being a pathological person means not being an efficient and productive person.
That is why, as Chapter 4, “New Psychotherapy for Returning to Work,” shows, the purpose of treatment is understood to be to recover workers in the most “cost-effective” way, that is, to send them back to work; as Chapter 5, “New Causes of Unemployment,” shows, psychiatric interventions are introduced that find the cause of unemployment in the personality defects of individuals; and as Chapter 6, “Education and the Rise of New Managerialism,” even children’s test stress is medicalized.
This is likely the fundamental reason why the number of prescriptions for ADHD medication, known as "study aids" in Korean society, has more than tripled over the past five years, and the number of patients with mental illness in youth continues to increase.

Beyond the neoliberal society that treats pain as a treatment

Those who advocate for the 'demigmatization' of patients with depression argue that depression is a 'cold of the mind' that anyone can contract, and therefore anyone should be able to easily receive a 'depression' diagnosis and treatment.
However, no matter how much you destigmatize people by saying that it is not your fault that you have a disease, being diagnosed with a disease that can affect anyone ultimately means that recovery depends on the individual above all else.
What it really means to have a society without the stigma of depression is that more people should be diagnosed with depression, and as a result, more people should be consuming treatment products.
This is also the reason why the theme of Chapter 8, “Enough with Materialism,” is materialism.

In this way, the therapeutic worldview conceptualizes mental suffering as a disease that anyone can catch, like a cold, a problem with serotonin in the brain.
But if depression is a normal condition, a condition that everyone experiences, then isn't there any need to question the prevalence of suffering in modern society? Rather than simply offering shallow solace by claiming suffering is normal, can't we create a society where suffering is less severe in the first place? The worldview psychiatry promotes deeply undermines our ability to answer these questions, offering a way of understanding depression that is at its most depoliticized and marginalized.

Therefore, as the title of Chapter 11, “Social Determinants of Pain,” suggests, the author’s core argument is that we need not only policies and legislation sensitive to social factors, but also a shift in the political and economic paradigm that will ultimately enable a fundamental reform of how we understand mental health.
A diagnosis of depression is not always necessary to understand and help someone who is suffering.
Yet the fact that so many people feel the need for such a diagnosis simply to acknowledge that they are suffering shows just how unforgiving our society is towards those who are suffering.


However, 'social solidarity and political community' are the most effective solutions and painkillers invented to deal with the pain that humans cannot handle alone, and conversely, the ability to talk about pain and show solidarity is the very condition for the establishment of relationships and community.
In a society that seems more materially affluent than ever, we keep hearing news that we are more lonely and depressed than ever before, because we have forgotten that reflecting on our shared suffering and uniting for change is the only way to build meaningful relationships and lives.