For the past century, it’s been a mainstay of the science fiction genre: the medicated society—a society in which the majority of the population is given some form of drug to alter their behavior, ostensibly for the better.
The most famous example of the genre is, of course, Aldous Huxley’s novel “Brave New World,” published in 1932. In Huxley’s vision of the 26th century, the drug Soma is used to ensure the obedience of the lower classes of a “perfect” eugenic world, where people are bred specifically for the social function they perform.
More recently, in the Christian Bale film “Equilibrium” (2002), the citizens of a totalitarian city-state must take an emotion-killing drug as a means to prevent war. Those who refuse to take the drug, called Prozium, are labeled “sense offenders” and are violently hunted down and sentenced to death by a special caste of “clerics.” Art, literature, and any expression of human emotion and creativity are prohibited.
Science fiction writers return again and again to these scenarios because they raise fundamental questions about the nature of authority and social control. In doing so, they also ask us to question what it is that makes us truly human.
Would it be desirable to eliminate human imperfection with something as simple as a pill? Would the loss of certain “negative” or “destructive” aspects of our humanity be justified by the net gain to social order and the reduction in suffering? And would it be better to try to persuade ordinary people to surrender these aspects of themselves voluntarily for the greater good, or would an “enlightened” class of rulers have every reason to force people to do so, perhaps even without their knowledge?
It isn’t just anti-depressants that Scots are swallowing in record numbers. According to figures published by The Mail, more than a third of Scottish adults are now being prescribed drugs from one of five broad classes associated with mental health issues. This includes a further 200,000 adults taking benzodiazepines, which are prescribed for anxiety and insomnia, and 190,000 who take gabapentinoids. Another 130,000 adults are given so-called z-drugs (such as zopiclone and zolpidem), and more than 800,000 are on opioid-based pain medication.
A situation like this doesn’t emerge overnight. It’s taken decades for Scotland to reach this point. The problem was already bad enough in 2007, when the ruling Scottish National Party (SNP) first came to power, that the government made a pledge to reduce the country’s dependency on anti-depressants. Instead, the figures have risen every year since. By 2010, 630,000 adults were taking anti-depressants, and an extra 390,000 were added over the next 12 years. There’s no reason to believe the trend won’t continue.
Politicians are now asking serious questions.
“The sheer number of prescriptions being issued for depression and anxiety in Scotland is astonishing,“ Conservative Member of the Scottish Parliament Maurice Golden told The Mail. ”The fact it has risen so considerably requires urgent and serious attention from the Scottish Government.
“There was a time when the SNP pledged to reduce the rise in these prescriptions, but it has only ever gone in this direction since.”
So why is this happening? A representative from Scotland’s Royal College of Psychiatrists, Jane Morris, suggested it may simply be due to increased public knowledge of mental health issues and the treatments on offer.
“We’d like to think public education and awareness of the treatability of mental illness means that more people are coming forward,” she told The Mail.
On this view, the number of people suffering from depression would be fixed, more or less: All that actually changes is how many people decide to seek treatment. We’re supposed to conclude, then, that at least a quarter of the adult population of Scotland has always been depressed. You don’t need to be an expert to have serious doubts that this could ever actually be the case. Ms. Morris did at least acknowledge that “increased prescribing may now reflect a rise in Scotland’s need for mental health treatment.”
Getting to the bottom of the problem is likely to prove difficult. And the difficulties are only made more acute by the fact that anti-depressants don’t really work.
But, more fundamentally, our reliance on drugs that don’t really even work is preventing us from understanding the root causes of depression and devising new ways—real ways that work—to address them.
This is a textbook case of what the philosopher Ivan Illich called “iatrogenesis,” or “medically caused harm.” In his famous book “Medical Nemesis” (1975), he argued that the growing medicalization of society is having the paradoxical effect of making us less and less well. In particular, what medicalization does, according to Mr. Illich, is reduce our capacity to respond to our problems of health and well-being in suitable ways.
When we see illness simply as an issue to be solved by technical interventions—with pills, injections, and surgery—administered to us by an anointed class of experts, we lose the ability to see illness on any other terms, as anything else. Like, for example, the product of a mismatch between our nature as human beings, stretching back 200,000-plus years, and the very different social world we now inhabit. There’s no pill or surgery that can cure that.
There’s still much investigation to be done of what’s clearly a very complex issue. But we would be fools not to heed the warnings of the thinkers who have shown us, on the page and on the screen, the dangers of a world of total medication. If we really want to do something about the massive rise in depression, in Scotland or anywhere else, we must face the possibility of a new Brave New World, one in which pills aren’t the answer to all our problems.
