Neoliberalism's Role in the Medicalization and Commodification of Mental Health

Research Article
Humanity & Society

2014, Vol. 38(4) 414-442
Neoliberalism and the ª The Author(s) 2014

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Commodification of DOI: 10.1177/0160597614544958
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Mental Health
Luigi Esposito1 and Fernando M. Perez1
Abstract
This article contributes to the existing literature on neoliberalism as an ideological
hegemonic project by addressing how the image of social reality it advances nor-
malizes the medicalization of human life. Because success, virtue, and happiness in a
neoliberal market society are often associated with material wealth, prestige, and
‘‘coming out on top,’’ it follows that normalcy itself is typically conceived along these
reified objectives. Acquiring services and/or products that might aid people to meet
these results is thus viewed as benevolent and perhaps even indispensable in the
pursuit of a fulfilling and productive life. What this also suggests is that integration,
mental health, and human well-being become largely functions of consumerism. We
address how an emphasis on medicalization, particularly the use of psychotropic drugs,
can be traced to the psychopharmacological revolution of the mid-twentieth century
and its obsession with situating illness within the individual. We then address how this
obsession with medicalization and the tendency to treat ‘‘mental illness’’ as a problem
within the individual continues to be supported within the prevailing neoliberal logic
that downplays the social realm, treats individuals as self-contained agents, and
pathologizes thoughts and behaviors that deviate from what the market defines
as functional, productive, or desirable.
Keywords
neoliberalism, medicalization, mental health, consumerism, commodification
1
Barry University, Miami, FL, USA
Corresponding Author:
Luigi Esposito, Barry University, 11300 NE 2nd Ave Miami Shores, Miami, FL 33161, USA.
Email: lesposito@barry.edu
Esposito and Perez 415
Personal Reflexive Statements

Both authors have been engaged in activist scholarship throughout their careers and
have written about the effects of neoliberalism on various issues. These include the
link between neoliberal ideology, excessive consumerism, and human rights; the
commodification of water system; the privatization of prisons; and the link between
neoliberalism and post civil rights racism. Both authors teach courses in which they
address the institutional and ideological forces driving the medicalization of human
life and its social consequences. Both authors teach at a mission driven university
that emphasizes the need to promote social justice. Currently, both authors are
working on a documentary addressing the effects of mass incarceration on urban
minority communities in Miami Dade County, and how this trend is tied to
neoliberalism.
Introduction
The latest version of the dominant classification system for the diagnosis of people
with mental health troubles, Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5), was released in May 2013. This latest edition of the Diagnos-
tic and Statistical Manual of the American Psychiatric Association (APA) represents
the culmination of a process that began a decade ago, when the leadership of the
APA and the National Institute of Mental Health agreed to work together on an
agenda to ‘‘expand the scientific basis for psychiatric diagnosis and classification’’
(APA n.d.). The well-known debates and controversies that have surrounded this
central objective, which actually began three decades earlier with the publishing
of DSM-III in 1980, have once again intensified in light of new developments asso-
ciated with the latest edition of this manual.2
Reminiscent of the voices associated with the antipsychiatry movement from
over half a century ago, many contemporary critics argue that efforts to expand psy-
chiatric diagnoses and classification lead to the increasing medicalization of human
life and the ‘‘potentially harmful interventions’’ that follow (British Psychological
Society n.d.). These critics have also noted that this process has made evident what
has been argued for decades. That is, mental health concepts are social constructions.
As such, the classification of mental disorders is a process that, far from purely sci-
entific, is shaped by political and/or profit-driven objectives associated with the
increased corporatization of medicine, including the mental health field (e.g.,
Jasso-Aguilar and Waitzkin 2012; Thomas et al. 2005; Timimi 2012a; Watters
2010; Whitely and Raven 2012).
As these constructs are promulgated by many in the medical field as medical
facts, mental disorders become viewed as conditions largely divorced from social,
economic, and political contingencies and turned into personal pathologies that can
be diagnosed and treated through the allegedly value-free traditions and naturalistic
methods of science and medicine. As a result, these presumed illnesses and their
416 Humanity & Society 38(4)
treatments are turned into commodities, or brands, that can be bought and sold.
And while critics are correct in demonstrating that the corporatization of mental
health is clearly a central factor leading to the increased medicalization of human
life, a thorough appreciation of this process, particularly within the current histor-
ical context, also requires a critical understanding of the metaphysics—that is, the
image of social reality—that dictates what is normal or pathological within a
market society.
For over three decades, this market society is often associated with the term neo-
liberalism. Although often linked to promarket policies such as deregulation, priva-
tization, and liberalization, neoliberalism is far more than simply a set of policy
prescriptions. Neoliberalism supports a type of order and vision of the world in
which all aspects of social, cultural, and economic life are shaped by what is some-
time referred to as ‘‘market rationality’’—that is, evaluating the merit of all actions
according to what is deemed as valuable, acceptable, or desirable by ‘‘the market’’
(Brown 2006; Currie 2006; Esposito 2011; Giroux 2008). The market, in this sense,
is widely regarded, either explicitly or implicitly, as an autonomous and self-
regulated entity that defines reality and hence requires no basis for legitimacy out-
side its own logic (Esposito 2011; Giroux 2008). Accordingly, encouraging people
to adjust their attitudes, habits, and behaviors to fit market demands is typically asso-
ciated with functional/rational behavior. Not accepting or failing to become fully
integrated into this market reality is, at best, regarded as a type of irrational/unpro-
ductive idealism, or, even more typically, associated with personal deviance and/or
pathology.
As an illustration of this latter possibility, one might consider that condi-
tions such as anxiety and depression (among many others) are treated as
self-contained ailments that can be resolved individually through pharmaceuti-
cal drugs, as opposed to being by-products of a market society, where the emphasis
on profit/personal gain and competition erodes social bonds and promotes aliena-
tion. In short, because the ‘‘market reality’’ to which people are made to adapt is
largely sequestered from scrutiny/critique, medicalization becomes a perfectly legit-
imate approach to ‘‘help’’ people. Prescription drugs, in this sense, are often
designed to modify behaviors to fit normative patterns of neoliberal agency (e.g.,
suppress feelings of depression and anxiety to enhance personal focus and compet-
itive/productive behavior, thereby promoting better results in one’s job, school, per-
sonal life, etc.). In effect, because success, virtue, and happiness in a market society
are often associated with material wealth, prestige, and ‘‘coming out on top,’’ it fol-
lows that normalcy itself is typically conceived along these reified objectives (e.g.,
Pérez and Esposito 2009). Acquiring services and/or products that might aid people
to meet these results is thus viewed as benevolent and perhaps even indispensable
in the pursuit of a fulfilling and productive life. What this also suggests is that inte-
gration, mental health, and human well-being become largely functions of consu-
merism (i.e., these goals require that people conform to the neoliberal notion that
their primary role is that of a consumer). As a result, this neoliberal image of reality
legitimizes notions of normalcy and/or sanity as commodities to be bought, sold,

and profited from.
Although much has been written about the corporatization of medicine, this arti-
cle moves beyond this theme by addressing how the mental health field—including
many of its goals, how it understands normalcy, how it conceptualizes disease, and,
most significantly, its obsession with medicalization/pharmaceuticalization3—is
currently shaped by prevailing neoliberal market values and structures that are too
often conceived as constitutive of an unassailable ‘‘reality’’ and therefore left
unchallenged. In effect, this article contributes to the existing literature on neoliber-
alism as an ideological hegemonic project by addressing how the image of reality it
advances normalizes the medicalization of human life. Our discussion proceeds as
follows.
First, we outline how this tendency to base medicalization, particularly the
use of psychotropic drugs, on what are presumably naturalistic, value-free stan-
dards can be traced to the psychopharmacological revolution of the
mid-twentieth century. During this time, drugs became the primary treatment for
presumably pathological behaviors and conditions that were sought in fixed bio-
logical properties within the individual. As a result, the psychopharmacological
revolution largely ignored the social dimension of what is defined as ‘‘mental
illness.’’
Second, we address how this obsession with medicalization and the tendency to
treat ‘‘mental illness’’ as a problem within the individual (while ignoring the social,
cultural, and economic dimensions of this problem) continues to be supported within
the prevailing neoliberal logic that downplays the social realm, treats individuals as
self-contained agents, pathologizes thoughts and behaviors that deviate from what
the market defines as functional, productive, or desirable, and equates happiness and
personal fulfillment with success in the marketplace. Indeed, current dominant
approaches within psychiatry, and the mental health field more generally, focus pri-
marily on encouraging individuals to better integrate themselves into the market
society or helping them to better cope with the various challenges (e.g., loneliness,
apathy, competition, etc.) that are prevalent in such a society. As discussed by
Richard U’ren (1997):
Psychiatry and psychotherapy represent modes of treatment that have evolved not only
to provide relief of symptoms, but also comfort, encouragement, and personal attention
to lonely and demoralized individuals in a [market] society where close personal rela-
tionships and community are often absent. (p. 5)
Consequently, most current psychiatric treatments merge with neoliberal ideology, as

the individual becomes the focus of attention while the larger market society in which
they live is largely ignored. The use of psychotropic drugs, of course, continues to be
the primary approach to ‘‘treat’’ individuals by allowing them to overcome their per-
sonal challenges and ‘‘fit’’ into the prevailing market order. Fitting into this market
society/order typically entails alleviating emotional/mental distress as a way to

enhance people’s productivity and capacity to consume. As stated by U’ren (1997):
. . . both capitalism and psychiatry place high value on work and productivity. Capital-
ism ascribes good character to the individual who works conscientiously and promotes
hard work as the route to individual success. Psychiatry reinforces this by maintaining
that the ability and desire to work (and consume) is a sign of mental health. (p. 4)
Presupposed by all this is that the market reality within which individuals exist (and
uphold through their daily actions/interactions) is beyond question. Therefore, men-
tal health must necessarily be conceptualized and achieved within the ontological
confines of the marketplace.
Finally, we argue the need for calling into question the metaphysics of the market.
That is, only by opening the reality of a market society to critical evaluation can def-
initions of sanity/normalcy begin to move beyond sanctified market standards and
reflect more fully the richness, diversity, and complexity of human/social life. We
address the ex-patient movement as a case example that illustrates the need for this
sort of shift.
Neoliberalism and the Market Society

Neoliberalism can be generally described as a broad-based political and intellectual
movement to advance the market as the most efficient mechanism for organizing vir-
tually all aspects of human/social life. Developed in opposition to Keynesianism and
similar theories calling for a regulated economy and a strong welfare state in the
early to mid-twentieth century, the architects of neoliberalism, which include lumin-
aries such as Friedrich Hayek and Milton Friedman, understand the free market as an
apolitical force that fosters personal liberty, encourages individual responsibility,
ensures the most efficient utilization of all social and economic resources, and pro-
motes an optimal way of life (Harvey 2005). A conviction that the market should be
‘‘the organizing principle of all political, social, and economic decisions’’ is thus
what drives the neoliberal agenda (Giroux 2008:2). Implementing this agenda
involves, among other measures, cutting taxes, curbing government spending (par-
ticularly on social services), doing away with unionized labor as much as possible,
and slashing regulations to create a social, legal, and political environment that is
conducive to business. In the United States, this project began in the 1980s under
Reagan and continues to be pushed with religious-like zeal by various powerful peo-
ple in government, the corporate sector, and by influential think tanks and research
centers such as the Project for a New American Century, the Brookings Institute, the
Cato Institute, the National Endowment for Democracy, and several others (Heron
2008).
In recent years, there has also been a proliferation of scholarship that focuses on
different aspects of neoliberalism (Springer 2012). For example, scholars have
focused on neoliberalism as a series of promarket/procorporate policies (e.g., dereg-

ulation and privatization) and their impact on the developing world (Breener and
Theodore 2002; Martinez and Garcia 2000), and/or a movement to integrate state
and market operations (Soss, Fording, and Schram 2009; Wacquant 2010), and/or
a type of ‘‘governmentality’’ that manages human subjectivities and population pol-
itics (e.g., Cotoi 2011); and/or an ideological movement that benefits the interests of
corporations and a transnational elite (Cox 2002). Within the medical field, various
writers—either explicitly or implicitly—have shown how neoliberalism supports,
among other things, a type of health care system in which health care delivery
becomes a commodity as opposed to a right (Jasso-Aguilar and Waitzkin 2012;
Shaffer and Brenner 2004; Thomas et al. 2005); patients are treated as customers
(e.g., Timimi 2012a; Watters 2010); and holistic treatments/interventions are dis-
couraged or marginalized (Frank 2002). Furthermore, much has been written about
the powerful pharmaceutical lobby in Washington and its effects on shaping the U.S.
health care system around an emphasis on deregulation (Potter 2013).
Because neoliberalism has increasingly shaped the medical field (including men-
tal health care) according to the logic of the market, psychopharmacological solu-
tions to mental health problems are increasingly fueled by conceptions of self,
health, and normalcy that are defined on the basis of commercial appeal. For exam-
ple, much has been written about the economic mandates guiding the psychophar-
macological era and the perils of direct-to-consumer (DTC) advertising and the
drug industry’s open sponsorship of medical research and education, particularly
in light of reports in the United States that virtually all doctors receive perks from
drug companies (Emery 2007).
As DTC advertising becomes ubiquitous in the United States (to date the United
States is only one of the two developed nations that allows this form of advertising),
its influence on both patients and physicians has led to substantial increases in the
number of prescriptions written and a corresponding rise in the medicalization of life
(Timko and Chowansky 2008). The impact of the pharmacological industry on phy-
sicians’ understanding and use of drugs through conferences, research sponsorship,
and other educational forms has also been well reported on. Both scholars and jour-
nalists have exposed how the pharmaceutical industry has enabled the dominant nar-
rative concerning mental health by hosting conferences, training seminars, funding
research, and, of course, promoting ever-present branding and product placement.
The evidence is also compelling that the pharmaceutical industry has a significant
influence on scientific research, thereby compromising its alleged neutrality. As one
author surmised, ‘‘ . . . the very epistemological basis that scientists, regulators,
juries, physicians, and patients rely upon to assess the safety and adequacy of indus-
try products’’ has been transformed (Robertson 2011). Even articles in medical jour-
nals have been exposed as promoters of the pharmaceutical industry. As a top
medical journal editor states, ‘‘[j]ournals have devolved into information laundering
operations for the pharmaceutical industry’’ (quoted in Robertson 2011). It is in this
respect that Healy (2002:311) declares the current state of psychiatric scientific
literature to be the ‘‘equivalent of a Big Mac’’—a metaphor quite fitting within the
neoliberal emphasis on commodification.
Nevertheless, our emphasis here is not so much on analyzing neoliberalism as a
series of policies or a type of procorporate/promarket government but rather as an
ensemble of ideological and institutional forces whose primary aim is to construct
a specific social reality in which virtually all aspects of human life—including
human relations, forms of subjectivity, modes of conduct, and/or personal objec-
tives—are managed and evaluated on the basis of market demands. To borrow
from Elliot Currie (2006), we emphasize how neoliberalism promotes not simply
a market economy but a market society in which market imperatives, ‘‘instead of
being confined to some part of the economy . . . come to suffuse the whole social
fabric’’ (p. 319).
The Market as the Arbiter of Human Life

Important to stress at this juncture is that far from simply a theory, economic
model, or set of policies, neoliberals insist the market is akin to natural law (Ber-
dayes 2011; Hinkelammert 1984). Similar to an ecosystem, the market works best
when unaffected by politics, culture, and other human influences that, throughout
much of the Western tradition, have been identified as sources of corruption, bias,
and error (Murphy 1989). And while it is clear that the market is, in actuality, far
from ‘‘free’’ and routinely manipulated to disproportionately protect the interests
of corporations and investors, neoliberals insist that the market is, at least in its
ideal form, ‘‘wiser’’ than humans. The problems that arise are almost invariably
attributed to restraints imposed on the market by entities such as the state or labor
unions. Indeed, neoliberals accuse ‘‘activist governments’’ that want to guarantee
more equitable social or economic results (e.g., through wealth redistribution
efforts, affirmative action programs, etc.) as guilty of promoting a corrupt form
of ‘‘social engineering’’ that distorts the market’s natural equilibrium; undercuts
efficiency; and invites different social ailments such as laziness, moral corruption,
and a lack of self-reliance. Solutions, therefore, involve eliminating these corro-
sive forces from the marketplace. In effect, the most effective solution to any
social or economic problem is always a market solution. Implied, of course, is a
form of market fundamentalism that is at the heart of the neoliberal project
(e.g., Esposito 2011).
By granting the market this sort of lofty status, market values, which include,
among others, individualism, self-reliance, consumerism, and personal gain/profit
currently shape what is often regarded as rational, responsible, and/or productive
forms of human agency. Rational behavior, stated otherwise, is predicated on peo-
ple being able to read market signals that will produce optimal or profitable results
(Arxer, Van Lear, and Lodge 2011). Thus, for example, in using education as a
means to become marketable, prioritizing personal gain over issues related to
social and economic justice, and avoiding ideals or ambitions that are not valued
at the marketplace, most persons do not necessarily think they are conforming to
specific market values, but rather believe they are simply being ‘‘rational’’ and
adapting to the real world (Esposito 2013; Serrano-Caldera 1995). Neoliberalism,
in this sense, advances a Foucauldian form of ‘‘governmentality’’ or what Wendy
Larner refers to as ‘‘market governance.’’ Referring to the neo-Foucaldian litera-
ture, Larner (2000) states:
This literature makes a useful distinction between government and governance, and
argues that while neoliberalism may mean less government, it does not follow that
there is less governance. While on the one hand neoliberalism problematizes the state
and is concerned to specify its limits through the invocation of individual choice, on the
other hand it involves forms of governance that encourage both institutions and indi-
viduals to conform to the norms of the market. (p. 12)
Because market norms in a neoliberal society are often conceived as facts of nature,
subjects under neoliberalism regulate themselves on the basis of common sense
assumptions and modes of rationality that support the prevailing market order and
the status quo that is structured therein (Larner 1997, 2000).
Within the market version of social reality, the individual is understood as the
only viable unit of concern and analysis (Esposito 2011; Giroux 2008). The idea
of ‘‘society’’ is therefore little more than a heap of individuals. What this also sug-
gests is that the private realm is prioritized over the social sphere. That is to say,
rather than emphasizing the web of institutional forces and social relations that shape
individuals’ behaviors and decisions, human agency is understood as simply a matter
of individualized choices and private pursuits. People, in effect, are autarkic beings
who ‘‘derive and renew their energy from within themselves’’ (Beck and Beck-
Gernsheim 2002:xxi). Consistent with classical liberal portraits of homo econom-
icus, this internal energy is also assumed to be largely competitive and self-
serving, both of which are tendencies that are valued in a market society. It is for
this reason that neoliberals insist the market is not simply an arbitrary institutional
design but rather an extension of human nature itself (Jameson 1991:263). There-
fore, anything that purports to deviate from the systemic contours of a market system
is assumed to deviate from the natural order of things.
Consistent with all this, subjects in a neoliberal society are considered nor-
mal and functional only when they show a willingness to compete with others
for the things that they need or desire and when they assume ‘‘personal respon-
sibility’’ for their own problems. In contrast, any person who fails to display
these qualities is assumed to fail not only as an economic actor but also as a
rational or responsible being (Soss et al. 2009:2). In fact, failing to display these
sorts of behavioral and/or attitudinal qualities is very commonly attributed to
some type of personal dysfunction or pathology. Furthermore, because the pre-
vailing market order is assumed to be fundamentally sound, blaming any beha-
vioral deviations or adverse conditions/circumstances on social, political, or
economic forces is typically regarded as little more than an excuse for problems
that lie within the individual. It is up to the individual, therefore, to overcome
whatever pathology they might have by taking the proper steps—for example,
seeking and being able to afford the proper medical/psychiatric treatment that
might enable that individual to make the necessary behavioral/attitudinal adjust-
ments that will lead to a happier, more productive, and fulfilling life. Failure to
take this sort of ‘‘personal responsibility’’ typically reinforces that person’s pre-
sumed pathology.
As the next section will show, these assumptions about mental health and the
individual that are currently associated with neoliberalism were also instrumental
in supporting the psychopharmacological revolution that began during the mid-
twentieth century. A brief history of this revolution is thus necessary to show its link
to central neoliberal tenets that, today, continue to support the medicalization of
human life.
The Psychopharmacological/Psychiatric Revolutions

and Social Control
The Market and the Biomedical Self
In 1980, the U.S. society witnessed both the official commencement of the neolib-
eral era with Reagan’s inauguration and the official onset of the ‘‘biomedical-self’’
with the publication of DSM-III. These events represent the maturation and contin-
ued expansion of a historical relationship between biomedical perspectives and the
neoliberal economic philosophies that have been evolving in the Western world for
over a century. More recently, the steady and dramatic increase in the medicalization
of life4 witnessed in the United States since 1980 has been dependent on the estab-
lishment of a market society and its insistence that market norms represent facts of
nature. In a similar manner, adherents of a biomedical understanding of behavior
depict human distress as resulting from impersonal (i.e., biological) forces acting
upon the individual. Modern inquiries into the causes of deviance and mental dis-
tress have thus sought knowledge that is devoid of social/experiential contingencies.
Just as a market that is tainted by human influences loses its presumed natural equi-
librium, subjective concerns in medicine are presumed to corrupt mental health
knowledge. In effect, dismissing political, cultural, and economic influences repre-
sents the only way to identify the actual cause of a mental ailment and the proper
corresponding treatment. It is in this respect that David H. Jacobs and David Cohen
(2010) argue that the objective of DSM-III was to effectively make ‘‘ . . . the human
world disappear’’ (p. 324).
Following a theoretical legacy that included black bile explanations for depression,
modern science has presented a host of varied somatic causes for human deviance and
distress that first gained popularity with the early positivist theories of phrenology and
‘‘atavism’’ (i.e., the idea, popularized by Italian criminologist Cesare Lombrosos in the
late ninetieth century, that many individuals who habitually engaged in deviant beha-
vior were evolutionary throwbacks or people who were biologically ‘‘primitive’’ and
‘‘unevolved’’). Various writers, accordingly, became critical of the significant influ-
ence on policies and programs of social control that these perspectives advanced. In
particular, writers from Marxist and liberal humanist traditions demonstrated how the
dominant ideologies of a society are reinforced through the medicalization process,
thus allowing existing social inequalities and injustices to be individualized and justi-
fied as natural (Lupton 1997). So, for example, when in 1907, the state of Indiana
became the first jurisdiction in the world to pass a mandatory sterilization law, this
development took place within a society that was experiencing significant social
changes (e.g., urbanization and industrialization). Furthermore, the popularity of ster-
ilization was made possible by the growing scientism of the era—an era in which the
ideas of Gall, Lombroso, and others served to justify social inequalities as biological
facts, as well as the exclusion and discrimination of certain ‘‘undesirable’’ social
groups as an indispensable strategy for promoting a healthy society.
Indeed, as the nation-state, in collusion with the medical establishment, took on
the task of improving the health of its society and its individual citizens, it seemed
only logical to end the reproductive capabilities of those that were biologically infer-
ior and/or disposed to deviance and abnormality. As the infamous Supreme Court
opinion by Justice Oliver Wendell Holmes Jr. declared, ‘‘three generations of imbe-
ciles are enough.’’ Consistent with Foucault’s idea of controlling the ‘‘dangerous
individual,’’ the Court’s support of eugenic doctrines clearly illustrates the utiliza-
tion of scientific and medical judgments in the name of collective security (Nye
2003). It would be the work of Foucault and his followers, moreover, which would
further develop the social constructionist ideas that medical knowledge represents a
belief system that is shaped by and through social, economic, and political relations
(Lupton 1997).
Neoliberalism, Medicalization, and the Maintenance of Order

The contemporary growth of medicalization emerged out of the psychotropic drug
discoveries that began with the introduction of chlorpromazine in the early 1950s,
the world’s first ‘‘antipsychotic’’ drug. Effectively marketed to be like a ‘‘chemical
lobotomy,’’ chlorpromazine’s impact on the world of psychiatry and the larger cul-
ture became widespread, immediate and innovatory, due in part to several factors.
First of all, there was an intensive marketing campaign, including the lobbying of
state legislatures and the underwriting of professional conferences, to secure the
drug’s use and acceptance. Of course, these efforts became magnified exponentially
within a few decades when these ideas converged with the market reality of the neo-
liberal consumer self (discussed in more detail later), thus effectively creating the
perfect environment for the commodification of mental states. But just as important
in fortifying the drug’s impact on the world of psychiatry is the pharmacological
effects that the drug produced and the significance of these effects in combating one
of the principal problems of state mental hospitals and of psychiatry in general—that

is, the maintenance of order.5
Drugs proved to be revolutionary in these settings precisely because they could
produce more manageable patients in a relatively quick, safe, and easy manner with-
out the invasiveness and obvious dangerous consequences of the previous shock and
psychosurgical therapies (e.g., lobotomy and electric shock therapy). With psycho-
tropic drugs, medicine finally possessed practical tools that could bring about order
and in the process present the specter of treatment to patients. This treatment, more-
over, would provide a form of psychiatric therapy that was emblematic and consis-
tent with the emerging new cultural narrative regarding deviance and sanity during
the 1960s and 1970s—a narrative clearly expressed by a growing antipsychiatry
movement that was critical of, among other issues, widespread hospitalization and
the violent treatment methods of psychiatry’s past (Dain 1989; Hopton 2006;
Roberts and Itten 2006).
Just as the development of psychotropic drugs became more sophisticated and
their pharmacological actions more specific, the relationship between medicine
and the state changed in conjunction with the alterations being ushered in by neo-
liberalism. One important consequence is that the collusion between medicine and
the liberal welfare state in increasing the direct control of those mentally unstable
becomes slowly displaced by the indirect control of the self that is necessary to
sustain a market society and the ensuing commodification of life (as can be drawn
from the fact that the growth of mental patients in state hospitals grew fourfold
between 1903 and 1955 from 150,000 to 560,000 but had decreased to 160,000
by 1977).6 And, as William Gronfein (1985:447) demonstrates, while it may
appear that drugs were responsible for these significant population declines,
analyses of discharge rates do not support this contention, as overall percentage
changes were greater before the drugs were introduced (from 1946 to 1954),
compared to the subsequent period. Rather, the significant decreases of the patient
population after the introduction of these drugs represented an extension, and not
the cause, of a discharge trend that had been taking place for some time. There-
fore, while the drugs played an important role in facilitating this trend, they were
not the causal factor. Instead, the deinstitutionalization movement of the second
half of the twentieth century was primarily the result of changes in social policy
and philosophy. As Gronfein (1985) states:
While [drugs] did help ‘open the back door’ of the state hospital, developments from
1965 onward—when deinstitutionalization accelerated markedly—were dependent on
a number of other factors including: the emergence of a civil libertarian reform move-
ment which transformed admissions and discharge procedures, the expansion of federal
health and welfare programs and the growth in nursing home capacity, and the devel-
opment of fiscal crises in many states. . . . the advent of psychotropic medications was
linked to the emergence of a new philosophy regarding what was possible and desirable
in the provision of mental health care for the seriously mentally ill. (p. 450)
In other words, changes being brought about by larger economic and social forces
were altering the roles of the state and medicine and the direct and often times
violent attempts by these institutions to control those facing mental distress. As
the eventual dismantling of the welfare state began to transform U.S. society into
the new market reality of a neoliberal world, replacing the nation-state citizen
with the neoliberal consumer required that methods of control also be modified
in dealing with issues related to sanity, mental health, and happiness. In this emer-
ging neoliberal market society, the commodification of mental health and the con-
sumption of chemicals to treat mental distress became a new form of social
control.
As medicine’s pharmacological ability to create specific pills for specific condi-
tions improves, a market solution for life’s troubles, in the form of drug consump-
tion, is greatly advanced. In this manner, the two major factors that led to the
widespread diffusion of the first ‘‘antipsychotic’’ drug and initiated the psychophar-
macological revolution—that is, marketing/branding and the maintenance of
order—are significantly reinforced upon merging with a neoliberal ideological and
institutional framework that promotes the market as the organizing principle of
human life and consumerism as the ‘‘ultimate form citizenship’’ (Giroux 2008).
As a result, social control becomes largely a self-induced form of violence as people,
mostly willingly, chemically modify themselves to better adjust to the market reality
demanded by neoliberalism. In this respect, as argued by Foucauldian theorists,
medical power acts to shape the parameters of what is appropriate, normal, and
healthy in a manner that is not simply authoritarian, but, more importantly, in the
discourses of how individuals should administer themselves, their lives, and their
aspirations for living (e.g., Lupton 1997). According to this view, as Deborah Lupton
(1997) surmises, ‘‘power as it operates in the medical encounter is a disciplinary
power that provides guidelines about how patients should understand, regulate, and
experience their bodies’’ (p. 99).
The ideological influence of neoliberalism on the medical establishment has
therefore encouraged an important shift in this institution’s focus. The central con-
cern is no longer to fill mental hospitals, promote eugenic programs, or shock some-
one into sanity but rather to normalize the consumption of psychoactive drugs as a
legitimate way of correcting (or dealing with) the sorts of adverse psychological/
behavioral conditions (e.g., feelings of anxiety, depression, insecurity, etc.) that are
encouraged within the prevailing market society. For this reason, challenging cur-
rent forces of medical control requires more than simply a movement toward deme-
dicalization. What is also needed is a concerted ideological opposition against the
basic assumptions and institutional practices that shape how we understand what
it means to be human and how society reacts to and attempts to control violations
against these conceptions. This endeavor demands exposing the increasing medica-
lization of life witnessed in the United States over the last 30 years as having been
largely a product of the market society’s insistence that human happiness, and the
treatment of mental distress, can only be achieved via consumption.
Consumerism and the Commodification of Mental Health

and Well-Being
Neoliberalism, Mental Distress, and the Consumer Self
What happens in a society that, as various critics contend, considers competitive
individualism as part of human nature, prioritizes business interests over workers’
rights, encourages private entities to prioritize profit/self-gain above all other val-
ues, promulgates self-reliance as the sine qua non of liberty, views compassion
and solidarity as optional, and conveys—through various means—all that this is
simply part of the ‘‘real world’’? Contrary to what many proponents of neoliber-
alism might claim, what results is, among other things, a weakening of social
bonds; the normalization of a survival of the fittest type of ethic; and a great deal
of discontent, social anxiety, and/or social/economic insecurity (e.g., Esposito
2011; Giroux 2008).
Since the neoliberal restructuring of the U.S. economy in 1980s, the country has
witnessed an erosion of decent paying jobs, stagnant wages, loss of work benefits,
increases in cost of living, and the dismantling of various social programs and public
services, particularly for the needy (e.g., Klein 2007). The argument can be made
that these conditions are at least partly responsible for, among other consequences,
increasing levels of stress (Jayson 2012), depression (Neighmond 2011), financial
insecurity (Rosen 2011), worker dissatisfaction (Saad 2012), and declining levels
of happiness compared to 30 years ago (Babington 2007). In a 2011 report, the Cen-
ter for Disease Control and Prevention (2011) estimates that nearly one in four
Americans suffer from a ‘‘mental illness’’ and that half of all U.S. adults will suffer
from a ‘‘mental illness’’ in their lifetime. Additionally, it is interesting to note that
while Prozac became one of the top selling pharmaceuticals shortly after being intro-
duced as an ‘‘antidepressant’’ in 1987, estimates of the frequency of depressive dis-
orders in the last half century have increased a 1,000-fold, from 50 to 100 per million
in the 1950s to 100,000 per million by 2000 (Healy 2002:69). In other words, after
decades of neoliberal policies and a psychopharmacological revolution that began
converting those suffering from mental distress into consumers, a large segment
of the U.S. population does not appear to be any saner, happier, less anxious, or less
distressed. In fact, the situation is quite the contrary. Since 1955, there has been an
‘‘astonishing’’ rise in the reported incidences of severe mental distress throughout
the United States, as every metric used to measure disabling mental distress in the
United States has risen dramatically.7 These trends, as Healy (2002) observes, can
be witnessed within all aspects of psychiatry:
Compared with 1900, when Kraepelin and Freud were putting forward the ideas that
would shape modern psychiatry, by 2000 there had been a fifteen-fold increase in rates
of admission to psychiatric wards. There had also been a three-fold increase in rates of
detention for psychiatric disorders. And psychiatric patients afflicted with schizophre-
nia or manic-depressive disorder, the disorders at the core of psychiatric business, were
likely to spend more time in a service bed during their psychiatric illness than they
would have done a century ago. (p. 329)
In short, the available evidence presents a rather bleak picture in that more people
are suffering from mental health issues than in the past, despite the rise in the number
of people receiving forms of available treatments (particularly drug treatments).8
These increases point not only to the failure of medicalization as the primary way
to deal with mental distress but also to the fact that neoliberal policies (particularly
from the 1980s onward) constitute a form of structural violence that has had a clear
impact on people’s mental health. Consistent with Johan Galtung’s definition of
structural violence, neoliberal policies and practices such as deregulation, deunioni-
zation, and outsourcing have essentially promoted the ‘‘avoidable impairment of
fundamental human needs’’ by depriving millions people of, among other issues, sta-
ble jobs, economic security, and a strong sense of community (Ho 2007:3). Yet con-
sistent with neoliberal orthodoxy, instead of addressing the larger ideological and
institutional forces that promote this structural violence and its effects on mental
health, the dominant solutions to dealing with the problem have been market solu-
tions that focus on the individual. Here again, the primary solution offered to people
who might be depressed, anxious, or dissatisfied is to overcome their ‘‘personal ail-
ments’’ by playing the role of consumers. Not only are people dealing with mental
health issues encouraged to consume pharmaceuticals as the primary way to deal
with their problems, but they also live in a cultural context that encourages forms
of ‘‘escapism’’ that, in turn, reinforces the market reality that too often brutalizes
them. Thus, for example, with a few exceptions, as people turn to television, video
games, and celebrity gossip as a way to ‘‘escape’’ their daily reality, they inadver-
tently continue to play the role of a consumer while being further indoctrinated into
the value system (e.g., the virtue of individualism, competition, wealth, materialism,
etc.) that sustains that prevailing market reality.
While a culture of consumerism has been around since at least the early twentieth
century, the advent of neoliberalism has reinforced the United States and other coun-
tries as ‘‘consumer societies’’ in which citizens (i.e., people with political rights and
obligations who are civically engaged and partake in the decisions and processes that
shape society) have been largely replaced by consumers (Bauman 1998). As stated
by Zygmunt Bauman (1998), ‘‘the role that our present-day [neoliberal] society
holds up to its members is the role of the consumer, and the members of our society
are likewise judged by their ability and willingness to play that role’’ (p. 36). Within
a consumer society, the rhetoric of commodities permeates social life. Thus, for
example, ‘‘rail and airline passengers become ‘consumers’ of service transport; one
attends university classes as a consumer of a degree . . . and a visit to a doctor is for
the purpose of consuming medical care’’ (Dore and Weeks 2011, para. 7).’’ In short,
under neoliberalism, virtually every aspect of human life, from vital needs such as
water, to spiritual salvation, to romantic interests, to public safety, is turned into arti-
cles of commerce—that is, products and services that can be purchased.
With respect to mental health, categorizations of mental and behavioral deficiencies,

upon entering the marketplace, become, to borrow from Sami Timimi (2012b), the
equivalent of ‘‘brands’’—that is, commodities to be bought, sold, and marketed like any
other commodity in the neoliberal economy (p. 157). Each ‘‘brand,’’ accordingly, will
develop a market that will include its own logo and slogan, professionals with expertise
in the specific condition, and, of course, the custom-tailored treatment (usually in the
form of a drug). For much of the public, therefore, human agency becomes little more
than an exercise in purchasing preferences, which is not only associated with freedom
but regarded as a way to achieve personal fulfillment. Indeed, competing at the market-
place to enhance one’s earning potential and broaden one’s ‘‘consumer choice’’ is tou-
ted by neoliberals as the primary way that people can improve the quality of their lives
and attain personal happiness and fulfillment (Pérez and Esposito 2009).
The neoliberal logic of commodification and consumer choice is also at the heart
of how ‘‘mental health,’’ particularly in the last few decades, is treated. Empowered
by the aforementioned neoliberal emphasis on market solutions, personal responsi-
bility, commodification, and consumer choice as the linchpins of a ‘‘free society,’’
the pharmaceutical and psychiatric establishments have been able to increase their
roles and influences in studies that have redefined ordinary human behaviors or oth-
erwise attributed problematic conditions such as depression and anxiety that might
stem primarily from wider societal conditions, as the avoidable effects of profitable
‘‘diseases.’’ To borrow from Ray Moynihan, Heath, and Henry (2002), pharmaceu-
tical companies, in concert with like-minded researchers, have become major pur-
veyors of ‘‘disease mongering.’’ They state:
Some forms of medicalising ordinary life may now be better described as disease mon-
gering: widening the boundaries of treatable illness in order to expand markets for
those who sell and deliver treatments. Pharmaceutical companies actively involved
in sponsoring the definition of diseases and promoting them to both prescribers and
consumers. The social construction of illness is being replaced by the corporate con-
struction of disease. (2002:886)
What should be noted at this juncture is that this idea of ‘‘disease mongering,’’ or
inventing an ever increasing number of ‘‘diseases’’ (and accompanying drugs that
are presumably antidotes to those diseases, or suppressors of their symptoms) is inti-
mately tied to the logic of consumerism. Indeed, it is precisely this sort of dynamic
that sustains a consumer society. As described by Bauman (1998:38), because the
satisfaction that comes with material consumption is typically short lived, encoura-
ging people to remain reliable consumers involves constantly enticing them with
new products. Through this process of continuous enticement (which is made even
more compelling when the presumably beneficial effects of those products are
endorsed by ‘‘experts’’ associated with the medical field), people are discouraged
from seriously questioning the legitimacy of presumed diseases that they are being
sold or reflecting on the larger societal condition that might be promoting whatever
adverse conditions they might be experiencing. It is this sort of alienation that paci-
fies many people and encourages them to simply conform to the prevailing market
reality that dictates all acceptable options. In effect, within this worldview, social
control is simultaneously ubiquitous and ostensibly unobtrusive, as agents (consis-
tent with Foucault’s conception of power) become self-regulated and self-correcting.
The power of how the medicalization, or the pharmaceuticalization, of modern
life is predicated on market forces that define reality is perhaps most clearly discern-
ible in pharmaceutical advertisements. While there exists a large literature addres-
sing how pharmaceutical companies advertise their products and pursue their
profit-driven objectives at the potential risk of bringing adverse effects to consu-
mers’ health (e.g., Chandra and Holt 1999), the argument can also be made that mil-
lions of people are willing to accept the potential health risks of consuming those
products, including death itself, which many pharmaceutical advertisements actually
divulge as a potential ‘‘side effect.’’ In effect, what is being ‘‘sold’’ by these adver-
tisements is not simply a drug but an image of health and normalcy that, although
clearly based on human choices and profit-driven interests, is so powerful in defin-
ing ‘‘reality’’ that people are willing to risk death itself to attain the presumed
benefits.
Ironically, many critics identify the consumer role itself, and the drugs consumed,
as largely responsible for the increase in the dire state of mental health in the United
States and throughout the Western world. According to this position, all psychotro-
pic drugs represent foreign substances that disrupt brain function. Accordingly, psy-
chotropic drugs are, as the original marketing slogan for chlorpromazine accurately
stated, chemical lobotomies in that they effectively alter and/or damage the chemical
system of the brain in a manner not unlike the brain damage caused by psychosur-
geries and shock therapies (e.g., Breggin 2001). To borrow from Robert Whitaker
(2005:27), ‘‘psychiatric drugs induce a pathology.’’ Specifically, while many of
these substances can be effective in dealing with mental health–related symptoms
in the short term, like all drugs (legal or illegal), over the long term, they increase
the probability of a person becoming chronically ill or experiencing new and more
severe symptoms (Whitaker 2005:133). For this reason, psychiatrist Peter Breggin
(2001) cautions against the most recent wonder drugs of the psychopharmacological
era, Prozac and the SSRIs, ‘‘In a frightening but realistic sense, taking Prozac or
other SSRIs is like a stab in the dark—a chemical thrust into the largely unexplored,
unmapped region of life that is [the] brain’’ (p. 42). It is a cautionary claim that
would have been equally appropriate 40 years earlier in reference to lobotomies.
Commodification, Addiction/Dependence, and the Neoliberal Self

For many critics of neoliberalism, addiction and addictive behaviors are the predict-
able outcomes of a consumer society. In its most fundamental form, consumerism
advances the view that happiness can only be accomplished through consumption,
as these behaviors are intimately connected to ego, spiritual satisfaction, and
personal identity (Pérez and Esposito 2009). Within the context of mental health, the
irony is that as persons consume substances to alleviate their distress, they only find
a brief and fleeting satisfaction that can only be treated by more consumption, thus
effectively establishing a cycle of addiction. The psychiatric patient, in effect, is suc-
cessfully transformed into a lifelong drug addict. In many ways, this is essentially
the personification of the neoliberal consumer self.
Also important to note is that many of the pharmaceutical drugs today are not
meant to improve health itself but instead designed to enhance the body in such a
way that makes one more competitive, attractive, and/or marketable, all the while
dismissing the role of social structure in all these considerations. Consider the case
of Dr. Michael Anderson, a state of Georgia pediatrician who acknowledges pre-
scribing attention-deficit hyperactivity disorder (ADHD) stimulants to children for
poor academic performances, regardless of whether they fit the diagnostic criteria
for the presumed disorder. As fiscal considerations (among others) compromise the
quality of public schools throughout the United States, Dr. Anderson uses the drugs
to accomplish what the schools and its educators can no longer do:
I don’t have a whole lot of choice. We’ve decided as a society that its too expensive to
modify a kid’s environment. So we have to modify the kid. We might not know the
long-term effects, but we do know the short-term costs of school failure, which are real.
I am looking to the individual person where they are right now. I am the doctor for the
patient, not for society. (Schwarz 2012, para. 3)
Clearly, this example illustrates the problems of understanding human life in terms
of a market reality in which all forms of interventions are based on issues related to
cost-effectiveness and become centered on the individual, irrespective of the social
factors responsible for the presumed deficiency being treated. Even when there is no
pathology, simply failing to adhere to the demands of this reality can warrant phar-
macological intervention. As the parents of three children being prescribed the pow-
erful psychostimulant, Adderall, by Dr. Anderson acknowledge, ‘‘My kids don’t
want to take [the drug], but I told them, ‘These are your grades’. . . . If they’re feeling
positive, happy, socializing more, and its helping them, why wouldn’t you? Why
not?’’ (Schwarz 2012, para. 10). Similarly, a related news story asked the question,
‘‘Are anti-depressants good for a boost if you’re already healthy?’’ (Hellerman
2006). The underlying pronouncement is that consuming these drugs unequivocally
improves one’s life, irrespective of whether or not one is actually dealing with the
distresses typically associated with a market society. Therefore, an actual diagnosis
is largely inconsequential.
A reliance on advancing a consumer mind-set, moreover, means that the wide-
spread marketing of the drugs does not necessarily depend entirely on a biomedical
explanation, particularly when the brand is being introduced into non-Western or
nonfirst world environments. Indeed, laypersons outside North America and Europe
have had reservations endorsing, for example, biomedical ‘‘chemical imbalance’’
explanations for states of depression. Instead, they are more likely to attribute these
conditions to psychosocial factors (France, Lysaker, and Robinson 2007:415). To
illustrate this point, during the Argentinian economic crisis of 2001, very few phy-
sicians and members of the general public accepted the notion of depression as a bio-
logical disorder located within the individual. ‘‘Antidepressant’’ sales, nonetheless,
increased significantly during this period. As Andrew Lakoff (2004) describes:
These drugs found a different means of entering the professionally mediated market-
place: doctors understood and used SSRIs as a treatment not for a lack of serotonin
in the brain, but for the suffering caused by the social situation—the sense of insecurity
and vulnerability that the economic and political crisis had wrought. (p. 247)
In effect, it was about creating consumers, irrespective of the etiology of the disor-
der. Moreover, once these brands entered the marketplace, alliances and relations
became firmly established that initiated a movement toward the biomedical and neo-
liberal understanding of self, distress, and treatment (i.e., drug consumption). As in
the United States, through the sponsorship of advertising campaigns, seminars, con-
ferences, and other research-based initiatives, as well as through the utilization of
authority figures such as physician leaders, or ‘‘brand spokesmen,’’ as Lakoff
(2004) refers to them, Argentinian physicians and the general public eventually
came to accept the neoliberal ‘‘market reality’’ that emphasized consumerism as the
antidote to mental distress.
As the current era of globalization is being dominated by neoliberalism and the
market reality this ideology demands, the biomedical/consumer interpretation of
mental health is being widely exported around the world (Thomas et al. 2005).
Timimi (2012b), for example, discusses how the recent World Health Organization’s
Mental Health Gap Action Programme initiative works to implement a
‘‘ . . . fundamentally positivist technical and biomedical framework [as] the most
appropriate starting point for promoting mental health care around the globe’’ (p.
154). At the core of this initiative is the view that personal and mental distress rep-
resent problems that exist primarily within individuals and the key to solving these
problems is to expand mental health services that work at the individual level
(Timimi 2012b:156). Mental distress, as a result, becomes encapsulated within
Western biomedical dualisms associated with happiness/unhappiness, sanity/insan-
ity, and the corresponding mental disorders or diseases identified (e.g., ADHD,
depression, bipolar disorder, etc.), as universal and acontextual. Here again, these
classifications of distress are exported as conditions that exists independent of situa-
tional considerations.
As an example of this phenomenon, Vieda Skultans (2007) describes the psychia-
tric changes following the market transformations of the former Soviet Union in this
manner, ‘‘[s]o too the advent of a market economy in Latvia has made prominent the
idea of the self-propelled individual, both in economic and health discourses’’
(p. 29). As the Argentinian case presented previously illustrates, the effective
branding of depression and the drugs to heal it represents the successful articulation
of mental distress as a thing you treat individually, despite a cultural understanding
that emotional suffering can be due to larger social forces. Here again, this would not
make any sense without accepting the neoliberal market reality that diminishes
social context and only responds to individual suffering, similar to what drove the
psychopharmacological revolution and its biological reductionism (Pérez and Espo-
sito 2009). As Skultans (2007) surmises with respect to Latvia after the end of Soviet
rule and the introduction of market reforms, ‘‘ . . . economic inequalities are now
reflected in biological inequalities’’ (p. 45).
Ultimately, psychiatry and its psychopharmacological revolution has not been
able to produce quantifiable benefits, particularly in the West, where it is dominant
and well established (Timimi 2012a). Consider, as one example, that most accounts
of schizophrenia in the non-Western world report this condition as having a shorter
duration and better outcome than in the West (Warner 2008). As a result, many have
questioned the argument that schizophrenia is simply an organic disease, consider-
ing that nonorganic factors such as social reintegration appear to be responsible for a
better prognosis (Warner 2008). Other categories of mental health also report similar
outcomes. As Timimi (2012b) states:
Unlike the rest of medicine, no overall improvement in long-term prognosis for those
diagnosed with a mental disorder has been demonstrated in Europe and North America
over the past century. Some studies indicate the opposite, that compared to the pre-
psychopharmacological period there are more patients who have developed chronic
conditions such as chronic schizophrenia than in the past. In addition, there is copious
evidence that shows that outcomes for major ‘mental illnesses’ in the non industrialised
world, is consistently better than in the industrialised world and particularly among
populations who have not had access to drug based treatments. (p. 155)
This is a fairly remarkable and disturbing situation concerning the psychopharmaco-

logical revolution of the last 50 years and the significant amount of resources (drugs,
physicians, hospital beds, etc.) available in the West.
Conclusion
While there has been a proliferation of scholarship over the past few years effec-
tively describing how promarket neoliberal policies have impacted the medical field
in general, and the psychiatric/pharmaceutical industry specifically, our objective in
this article has been to move this discussion beyond considerations of economic pol-
icies and their outcomes. We argue that neoliberalism represents more than simply a
series of promarket policies and proposals. More specifically, neoliberalism sig-
nifies an ensemble of ideological and institutional forces whose primary purpose
is to create a social reality where all facets of human life are reduced to economic
concerns. Thus, far more than simply a market economy, neoliberalism demands
a market society, where definitions of normal, sane, and illness are determined
primarily by market considerations that are conceived by large segments of the pop-
ulation as akin to natural law.
Considering all this, there should be little doubt that the rise of neoliberalism has,
especially in the Western world, directly and profoundly contributed to recent devel-
opments associated with the understanding and response to mental health issues. In
particular, the ascension of the psychopharmacological revolution and the corre-
sponding medicalization of life has taken place in concert with the larger structural
developments that were established during the neoliberal era. As the welfare state
was beginning to be dismantled in favor of the neoliberal state, changes such as the
deinstitutionalization movement that occurred in the second half of the twentieth
century meant that the explanatory frameworks accounting for mental distress, and
the direct control of individuals dealing with these issues, would have to be altered.
More specifically, replacing the nation-state citizen with the neoliberal consumer
meant that the social control of those suffering from mental health issues would
no longer be conducted primarily via overt means (i.e., lobotomies, institutionaliza-
tion, and eugenics) but would consequently be accomplished via conformity to the
consumerist demands of the neoliberal society. As this commodification of human-
ity is expanded, mental health considerations are thus largely reduced to efforts that
advance the consumption of chemicals to adequately deal with life’s demands and
difficulties. As a result, social control becomes self-induced as persons chemically
modify themselves to better adjust to the reality of a neoliberal world, thereby equat-
ing happiness and the solution to mental distress with consumption. This process
ensures, moreover, that social considerations and holistic solutions for mental dis-
tress are effectively marginalized and discounted.
This commodification of mental health that has occurred over the last 30 years can
be clearly witnessed in the most recent movement within the mental health arena, that
of the ex-patients. The antecedents of this movement can be found in the critiques that
challenged the intellectual foundations of modern psychiatry during the 1960s and
1970s and in the corresponding deinstitutionalization and patients’ rights policies that
led to the release of hundreds of thousands of patients. Despite the variety of views and
interests of those who would be identified with the ‘‘antipsychiatry’’ or ‘‘critical psy-
chiatry’’ movement, at their core critics were united in their rejection of the medica-
lization of human distress and in exposing the violent and coercive nature of
psychiatry (Dain 1989; Hopton 2006; Roberts and Itten 2006). Drawing from the work
of writers such as Szasz, Foucault, and Laing, activists and mental health reformers
rejected the medical model of mental distress, denied the legal authority of involuntary
institutionalization and compulsory treatment, and sought the personal and political
empowerment of those dealing with mental distress (McLean 2000). Throughout the
1960s and 1970s the ex-patients who made up this movement (many formally institu-
tionalized) mobilized to free themselves from psychiatry, the mental health system,
and their dependence on both (McLean 2000).
By the 1980s, however, the radical thrust of the ex-patients movement, along with
the ‘‘critical/anti psychiatric’’ intellectual tradition that had spawned it, would
diminish considerably and give way to a new form of ex-patient activism and effort:
the ‘‘consumer/survivor’’ movement—as it is commonly identified. This new move-
ment would be propelled by a ‘‘user-centered’’ thrust that reflected concerns of self-
advocacy, consumerism, stake-holding, and self-determination (Hopton 2006:59).
According to some authors, one of the main factors that led to this anti-psychiatry
demise was the overall loss of the broad-based support that followed the decline
of other counterculture/leftist movements and coalitions (Rissmiller and Rissmiller
2006). Consistent with this view, by the 1980s, the feminist, antiracist, and anties-
tablishment agenda of many on the radical left were being displaced by an emerging
conservatism that was to dominate the political landscape. Ex-patients, mental
health service users, and their families, as a result, would rejuvenate this waning
anti-psychiatry movement by presenting mainstream collaborators who were more
representative, and differed slightly politically, from the general public (Dain
1989; McLean 2000; Rissmiller and Rissmiller 2006).
While many of these ex-patient activists held on to radical ideologies, they none-
theless devoted their efforts to the more practical and immediate concerns of those
with mental distress. Thus, by 1980, the weakened, disorganized, and politically
oppositional anti-psychiatry movement would take a ‘‘reformist turn,’’ where acti-
vists were beginning to advocate for change through lobbying, litigation, confer-
ences, and their own ex-patient alternatives; in effect, choosing to engage in
dialogue and being willing to work with psychiatrists, other mental health profes-
sionals, and government agencies rather than against them (McLean 2000). As
David J. Rissmiller and Joshua H. Rissmiller (2006) describe, these events would,
within a few decades, result in the ‘‘critical/antipsychiatry’’ movement being trans-
formed from a 1960s era antiestablishment movement seeking to dismantle orga-
nized psychiatry, to a patient-based movement advancing consumerist reforms.
The foremost goal of this new movement, accordingly, is the advancement of what
is referred to as ‘‘consumer empowerment.’’ Ideas of power/empowerment, their
meaning, and how to attain them have thus been altered significantly within the
ex-patient movement. Power, simply stated, has been equated with the ability to
exercise some form of choice within the mental health system, rather than the per-
sonal and political ability to be independent from that system (McLean 2000:837).
It is in understanding the significance and implications of the label of ‘‘consumer,’’
and the identity bestowed upon that label, that an appreciation of how neoliberal val-
ues and structures influence mental health issues becomes instructive. It is more than
simply coincidence that ex-patients began to be referred to, and began to self-identify,
as consumers in the beginning of the 1980s. Consistent with the rise of a neoliberal
market society and the corresponding emphasis on consumerism and ‘‘consumer
choice’’ as an empowering form of agency, notions of self-empowerment become
equated with individual access to the mental health marketplace. As defined by
Barbara Everett (2000), the consumer designation revolves around the perception
that mental health issues are best handled through business and marketplace
solutions:
[it] is a rather mild-mannered term that attempts to empower patients and clients by
equating them with customers—a term which, in the sphere of the marketplace, denotes
people who are respected because they demand satisfaction or else they take their
business elsewhere. (p. 145)
Consistent with our analysis of the psychopharmacological revolution and the rise of
the neoliberal consumer, this designation is built upon a general acceptance of the
biomedical model of mental distress and its chemical treatment methods (Everett
2000; McLean 2000). Unsurprisingly, as Athena Helen McLean (2000:840) observes,
the consumer movement is most developed in the United States where, consistent with
a capitalist market economy, the individual pursuit of personal fulfillment becomes
the primary objective.
There is, nevertheless, strong contention within the ‘‘ex-patient’’ movement over
the label and self-identity of consumer. Many activist within this movement are
highly critical of, and reject, the consumer identify, preferring to use the moniker
of ‘‘survivor.’’ Among other issues, these activists are critical of using a term that
they feel was imposed upon them from authority figures and signifies dependence
on the mental health system, ‘‘consumer also means dependence’’ (Everett
2000:146). The term ‘‘survivor,’’ on the other hand, was coined by ex-patients them-
selves and signifies, for many, a sense of pride and empowerment of surviving life’s
trials and tribulations, including the mental health system itself. Thus, while a con-
sumer is generally understood as ‘‘ . . . someone who consorts willingly with the
enemy without benefit of the political analyses . . . ,’’ the term survivor is
‘‘ . . . intended to convey strength in the face of adversity, a sense of optimism and
independence, and, above all, power’’ (Everett 2000:145-46).
One other significant point of demarcation that arises between the self-
identification of either ‘‘consumer’’ or ‘‘survivor’’ centers on the understanding and
nature of mental distress and the interventions necessary to deal with these issues. In
particular, for activists who utilize the ‘‘survivor’’ label, there is a continuance of the
‘‘critical/anti-psychiatry’’ stance against biomedical conceptions of mental distress
and its overreliance on psychotropic treatments. Survivors, accordingly, are more
inclined to focus on the social causes of mental distress and to advocate for changes
that impact these perceived forces. ‘‘Emotional and economic support’’ to combat
issues related to poverty, housing, and employment are, according to Everett
(2000:196), of central concern to these ex-patient activists. In effect, matters of
power and empowerment are understood to incorporate a social dynamic that moves
beyond the simplistic and naive individualistic tenor of consumer choices within the
mental health system. In this respect, these ex-patients demonstrate how people can
move beyond the all-encompassing neoliberal market rationality that reduces human
agency to consumerism.
In the end, as Everett (2000) describes, the fundamental concern for the ex-patient
movement, irrespective of the labels of survivor or consumer, essentially revolves
around the issue of power. Accordingly, failing to account for the rise of
neoliberalism and how this perspective/movement has influenced conceptions of

social reality—including dominant understandings of self and sanity—prevents a
thorough analysis of contemporary power relations and hierarchies. Outlining the
intricacies of this phenomenon has been the objective of this work. By opening the
metaphysics of the market to critical evaluation, we contend, social movements such
as the contemporary ex-patient movement can move definitions of sanity, normalcy,
and health beyond their neoliberal dimensions to more accurately reflect the com-
plexities of human life and, in the process, work to alter unjust, inequitable, and
authoritarian power relations.
Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of
this article.
Notes
1. The authors are listed in alphabetical order. Please send all correspondence to either
Dr. Luigi Esposito at lesposito@barry.edu or Dr. Fernando Perez at fperez@barry.edu
2. The objective to expand psychiatric diagnoses and conditions was based on a biomedical
approach to the understanding and treatment of mental disorders. Effectively, Diagnostic
and Statistical Manual of Mental Disorders, Third Edition (DSM-III) represented the
construction of a neo-Kraepelin diagnostic system whose primary aim, to borrow from
psychiatrist David Healy (2002:306), was to officially commence the era of the ‘‘new
biomedical self.’’
3. As discussed by Susan E. Bell and Figert (2012), there has been some discussion among
scholars recently on whether the modernist concept of medicalization is still adequate to
capture the complexities of this phenomenon in lieu of a postmodern understanding of the
diverse interactions between science, medicine, the pharmaceutical industry, and the larger
culture. As a result, scholars have introduced various concepts in an attempt to better cap-
ture the nuances of this phenomenon (i.e., phamaceuticalization, biomedicalization, and
geneticization). For our work, however, we will use these terms interchangeably as we feel
that they all address the same phenomenon under investigation, with the exception of a few
subtle differences. The fact remains that the complex and sometimes contradictory inter-
actions between the various actors that lead to an understanding of life struggles as medical
conditions have been witnessed throughout the history of modern medicine. Clearly, the
pharmaceutical industry has always played a significant role in the process of medicaliza-
tion and in the rise of the psychiatric field. Indeed, the modern psychopharmacological rev-
olution arose out of the discovery of synthetic dyes over a century ago, products that would
launch the modern pharmaceutical industry and its symbiotic relationship with the medical
establishment. What is needed, accordingly, is a concept that captures the changes of
understanding mental health within a neoliberal view of what it means to be human, nor-
mal, and sane; not just one that accounts for the pharmaceutical industry’s influence or
takes into account technological innovations. Until such a concept is introduced we prefer
to reference the well-known term medicalization.
4. To clarify, we use the term medicalization, as Peter Conrad (2000) outlines, to refer to the
transformation of human problems, particularly behaviors that are deemed to be deviant,
into medical problems—usually in terms of illnesses or disorders. More specifically, med-
icalization consists of (1) defining a problem in medical terms, (2) using medical language
to describe a problem, (3) adopting a medical framework to understand a problem, and (4)
using medical intervention to deal with the problem (p. 322).
5. As has been well documented, a vast majority of U.S. mental institutions were vilified as
‘‘bedlams’’ for their unsanitary conditions, for abusive treatment of patients, and for being
nothing more than warehouses without much to offer with respect to treatment. Conse-
quently, during this era, most hospital administrators were primarily concerned with issues
concerning the imposition of order and the maintenance of control within their institutions
(Gronfein 1985).
6. Figures cited in Gronfein (1985) and Cohen (1988).
7. As Whitaker (2005:23) reports, using the U.S. Department of Health and Human Service
‘‘patient care episodes’’ measure of the number of people treated each year for mental ill-
ness in psychiatric hospitals, residential facilities, and ambulatory care, in 1955, there were
over 1,000 episodes per 100,000 population. By 2000, patient care episodes had increased
fourfold to a rate of over 3,800 per 100,000 population. The U.S. population of disabled
mentally ill, correspondingly, has witnessed a sixfold increase since chlorpromazine was
introduced (with a significant increase in 1987, the year the anti-depressant Prozac was
introduced) as the disability rate has increased from 3.38 people per 1,000 population in
1955 to 19.69 people per 1,000 population in 2003.
8. These last points were further elucidated in a comparison of the number of psychiatric hos-
pital admissions in North-West Wales in 1896 and 1996 (Healy et al. 2001:779). Interest-
ingly, despite the passing of a hundred years, the population of North-West Wales has
remained similar in population size, ethnicity, and social composition; enabling a compar-
ison of incidence and prevalence of mental health service utilization over the course of a
century. Despite the psychopharmacological revolution and the promise of curing and
treating mental distress that was to follow, accordingly, the authors report substantially
more patients admitted for all diagnoses in 1996 compared to 1896, even when compari-
sons are restricted to detained patients. The authors were surprised, moreover, by another
discovery revealed by their data: the recovery rates for survivors were relatively good and
comparable to modern rates.
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Neoliberalism's Role in the Medicalization and Commodification of Mental Health

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Research Article

Humanity & Society

Neoliberalism and the ª The Author(s) 2014

Luigi Esposito1 and Fernando M. Perez1

Personal Reflexive Statements

legitimizes notions of normalcy and/or sanity as commodities to be bought, sold,

Consequently, most current psychiatric treatments merge with neoliberal ideology, as

society/order typically entails alleviating emotional/mental distress as a way to

Neoliberalism and the Market Society

focused on neoliberalism as a series of promarket/procorporate policies (e.g., dereg-

The Market as the Arbiter of Human Life

The Psychopharmacological/Psychiatric Revolutions

Neoliberalism, Medicalization, and the Maintenance of Order

of the principal problems of state mental hospitals and of psychiatry in general—that

Consumerism and the Commodification of Mental Health

With respect to mental health, categorizations of mental and behavioral deficiencies,

Commodification, Addiction/Dependence, and the Neoliberal Self

This is a fairly remarkable and disturbing situation concerning the psychopharmaco-

neoliberalism and how this perspective/movement has influenced conceptions of

Declaration of Conflicting Interests

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