I’m surprised that there’s controversy over the claim that people are over-diagnosed and over-medicated in a laissez-faire capitalist society. The medical establishment is part of a capitalist order that classifies and commodifies everything for profit, including human emotions and behaviours. Capitalism also suppresses dissent and resistance in order to maximise profit at the expense of workers’ needs and interests. In order words, capitalism reproduces the status quo of white, cisgender, male, able-bodied privilege. This is why bell hooks describes America as not only capitalist but “a white supremacist capitalist patriarchy.” The medical establishment is part of this system of interlocking oppressions. Pharmaceutical companies will diagnose and medicate whatever they can to turn a profit. Their only function is to increase shareholder value. If they can medicate everyone, they will. But because capitalism intersects with other systems of oppression, the people most susceptible to coercive pathologisation and medication are those most oppressed under capitalism – racialised minorities, women and sexual minorities, disabled people, and so on. Hence, these groups are medicalised and overmedicated in particularly unjust ways, which is well-documented across a range of literatures.
In “The Feminine Mystique,” Betty Friedan writes about how 1960s housewives were diagnosed with depression and prescribed barbiturates in order to sedate them and silence their legitimate complaints about patriarchal oppression. In “The Protest Psychosis: How Schizophrenia Became a Black Disease,” Jonathan Metzl writes about how Black activists in the 1960s were diagnosed with psychosis and sedated with anti-psychotics in order to silence their valid grievances about white supremacy. Disabled philosophers of disability like Shelley Tremain have written (on this blog and elsewhere) about how mental disabilities like autism and OCD (which I have) are forcibly pathologised by the medical establishment rather than being recognised as biopolitical constructs and sources of resistance and solidarity. As a result, disabled people’s experiences are trivialised, homogenised, and suppressed.
These are just a few examples of how the medical industry is complicit in the commodification and forced medicalisation of oppressed groups whose testimony poses a threat to the established order, groups that must be pathologised and sedated so as to silence them and profit off of their silent suffering. These are long-established interdisciplinary critiques of how capitalist institutions operate in general. While these critiques are susceptibly to criticism – for example, for lacking intersectional dimensions in some cases – they correctly identify a problem with dominant medical practices under neoliberalism. How is this controversial?
Perhaps one source of controversy is that these critiques could (incorrectly) be interpreted as being anti-drug. But this is far from the case. Drugs predate capitalism and have always been a feature of cultural, spiritual, and philosophical practices around the world. The main difference under capitalism is that some drugs are validated as “medicine” while others are labeled as “street drugs.” But this taxonomy is, once again, an artefact of neoliberal hierarchies. Suffice it to say that one can recognise the coercive medicalisation and sedation of oppressed people under capitalism without being against drugs per se. Indeed, drugs should be liberated from the coercive biopolitical practices that medicalise not only human beings and behaviours, but also drugs that should be widely available. Yet capitalist institutions coercively medicalise and medicate some oppressed people, while criminalising and incarcerating (AND often medicating) others, especially racialised minorities. This therapeutic/illicit dualism is a neoliberal invention that ensures that oppressed people will be managed, supervised, and silenced one way or another, and Big Pharma wins either way.
I wonder if anyone has ever done a study on whether people metabolize drugs differently based on whether they believe them to be illegal or not.