By Sami Timimi

In this original essay, child and adolescent psychiatrist and psychotherapist Sami Timimi applies a Marxist lens to the escalating mental health crisis in the West. He argues that the explosive growth of psychiatric labels, treatments, and the Mental Health Industrial Complex (MHIC) is no accident, but a structural response to late-stage capitalism in crisis. Amidst rising distress, alienation, and inequality, the MHIC commodifies suffering, depoliticises class conflict, and reinforces hyper-individualism—channeling discontent into individualised “disorders” rather than collective action. As a platform for critical reflection on psychiatric practice, we are pleased to publish this provocative analysis that links the failures of mainstream mental health interventions to the contradictions of neoliberal capitalism itself.

Introduction

In the developed West we live in societies where late-stage capitalism (sometimes referred to as ‘neoliberalism’) encourages a culture of compete and compare that permeates through society creating a model for what it means to be human. This encourages a neo-Darwinian framework of hyper-individualism where status anxiety and human typologies (often hierarchical in nature) replace social solidarity as the vehicle to deal with suffering and to create cultural, political, and ultimately economic change. Western psychology/psychiatry has long tried to develop a human typology where a type is considered better/healthier. From introvert/extrovert to so-called personality disorders, from management personality questionnaires to ascertain the ‘type’ of leader you are, to eugenics – context and development become secondary. Two core realities have emerged in recent years which require a rigorous analysis: the prolific spread of mental health labels and accompanying markets (assessments, therapies, programmes, courses, books, medications etc.) at the same time as declining levels of mental health (increased stress, suicides, alienation etc.). Both are likely to reflect a dynamic embedded in collapsing late-stage capitalist imperialism where a Mental Health Industrial Complex (MHIC) is tasked with absorbing distress and alongside identity politics helps to sweep up the detritus of the neo-Darwinian model into separated containers that keep populations from getting closer to experiencing class power. Accepting shaky definitions of mental distress by falsely calling them diagnoses is the equivalent of the social democratic attempt to save a failing system through reform rather than overthrow and the establishment of a new set of principles to run economy and politics. The approach of believing that we need to curb the excesses of the system so we can get a ‘balanced’ approach (such as reducing ‘over’ diagnosis) cannot work at this point. This is what saves a failing system rather than replaces it.

The Treatment Prevention Paradox

A cross-national analysis of population surveys using structured diagnostic interviews from 29 countries, report that by the age of 75 years, approximately half the population will have endured one or more mental health condition, which typically first emerged in childhood, adolescence, or young adulthood (McGrath et al, 2023). Studies using self-report questionnaires suggest even higher prevalence numbers. For instance, a survey in 2019 in the UK of one thousand young people found that 68% thought they have had or are currently experiencing a mental health problem. In addition, it revealed that there had been a 45% increase in mental health referrals of under-18s in the previous two years (Banham, 2019). Another 2019 paper using a child self-report questionnaire methodology, came up with a prevalence figure for mental health problems in 11- to 15-year-olds in the UK of 42% (Deighton et al, 2019).

These brief snapshots are typical of multiple studies that are reporting high levels of distress reflecting steep declines in mental health in the last few decades. This deterioration is happening across all age and gender groups, with English-speaking countries having the lowest levels of mental well-being, and the 18-24 age group having the worst mental health of all age groups (Sapien Labs, 2024).

At the same time as deteriorating mental health, the global mental health market size has been rapidly increasing reaching US$ 448 billion in 2024 and growing, meaning it has become a significant arena of economic activity (IMARC Group, 2024). While more is spent on treatment of individuals, the general population prevalence of conditions is still on the rise (Thornton et al, 2024). This dynamic of increasing volume and cost of treatment alongside increasing prevalence is often referred to as the Treatment Prevention Paradox (TPP).

This increased volume of treatments is not resulting in improved outcomes and therefore declining or stabilising prevalence (Batstra and Timimi, 2024).

In 2021, New York Times reporter Benedict Carey, after covering psychiatry for twenty years, concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health – rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use – went in the wrong direction, even as access to services expanded greatly.” (Carey, 2021).

In 2023, Jamie Ducharme reported, “about one in eight US adults now takes an antidepressant”; however, “mental health is getting worse by multiple metrics. Suicide rates have risen by about 30 per cent since 2000 . . . As of late 2022, just 31 per cent of US adults considered their mental health “excellent”, down from 43 per cent two decades earlier. Trends are going in the wrong direction, even as more people seek care. That’s not true for cancer, it’s not true for heart disease, it’s not true for diabetes, or almost any other area of medicine.” (Ducharme, 2023).

A 2023 study of Danish population records estimated that about 80 per cent of the population will receive psychiatric drug treatment in their lifetime. Furthermore, after receiving treatment (particularly if it was in hospital), they were more likely to experience new socioeconomic difficulties, become unemployed, receive a disability benefit, earn a lower income, live alone or be unmarried (Kessing et al, 2023).

A 2022 comprehensive review of outcomes for both psychotherapies and pharmacotherapies in mental health conditions concluded that “After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental health conditions are limited, suggesting a ceiling effect for treatment research.” (Leichsenring et al, 2022).

There are over 500 different forms of therapy documented and every year new ones come on stream. Not only has this proliferation of models not resulted in improved outcomes, studies also show that psychotherapy is less effective for those who have a lower income, minority status, or are on antidepressants (Finegan et al, 2020; Delgadillo et al, 2016; McPherson and Hengartner, 2019). Controlled trials that test efficacy of therapies have been conducted since the 1970s, but have not shown improved rates of recovery from treatment. Some comparisons even suggest outcomes from therapy in controlled trials have got slightly worse over time (Budd and Hughes, 2009; Drury, 2014; Friborg and Johnsen, 2017; Johnsen and Friborg, 2015; Weisz et al, 2017).

The proliferation of mental health treatments has not resulted in improved outcomes for those who seek help. In most healthcare fields it’s possible to see gradual, and sometimes sudden, improvement in outcomes. Survival rates after heart attacks have been increasing, average cancer survival years have improved for most cancers, and vaccination programmes have reduced the prevalence and lethality of many diseases. That’s what happens when the more objective metrics of care are central to outcomes, something that hasn’t been replicated for mental health treatments.

Perhaps further light can be shed on this conundrum of the expanding use of interventions with no demonstratable positive impacts at the population level, by examining the construction of human subjectivity in the societies our bodies and minds have to negotiate. For this task a Marxist understanding of the nature of social relations and its impact, from individual psychology to the exercise of political power, will be used.

Historical dialectical materialism

Dialectical materialism is the foundational Marxist method for studying phenomena of nature. Historical dialectical materialism extends the principles of dialectical materialism to the study of social life, society, and its history (Engels, 1878).

Contradictions are fundamental to understanding dialectics. There are inherent forces working in opposite directions that drive motion, change, and development. This ‘unity and conflict of opposites’ posits that opposing forces are constantly interacting, but also interlinked, and as they develop these can lead to new qualitative states emerging from quantitative change. By analysing these internal contradictions, such as the conflict between social classes or the opposing forces within an atom, one can understand the processes of transformation in both nature and society.

Nature and society are thus not in a state of rest, stagnation and immutability, but in the process of continuous movement and change, renewal and development, where something is always arising and something always disintegrating and dying away. Change does not take place as a harmonious unfolding of phenomena, but as a consequence of the contradictions inherent in things and phenomena – as a ‘struggle’ of opposite tendencies which operate on the basis of these contradictions.

Materialism also assumes that a concrete material world exists independently of human consciousness. Furthermore, that human ideas, culture, morality, and institutions are products of material social conditions, not the other way around, “It is not the consciousness of men that determines their existence, but their social existence that determines their consciousness” (Marx, 1859).

Dialectical materialism and historical dialectical materialism thus propose a holistic, systemic, and developmental model of the natural world, society, and therefore human consciousness. There is no fixed immutable state of nature or human nature. Our concept – our social construction – of what it means to be human changes as society changes, in much the same way as our sense of self changes as we grow from being babies to adults and into old age. As such our lives are defined by change and struggle occurring in the context of the material world we have arrived in.

Social constructionists view much of the knowledge we might take for granted as ‘common sense’ or simply accepted as true, as being constructed. This means much of what passes for widely accepted concepts, beliefs, norms, and values, are formed through continuous interactions among society’s members, instead of through objective observation of physical reality.

Karl Marx was perhaps the original social constructionist, making clear how difficult it is to imagine a world that operates in a way that is different to the world of social relations a person inhabits. He criticised the dominant themes in philosophical and cultural debates in 19th century Europe that was attempting to distil an abstract idea of ‘human nature’. Instead, he proposed that human nature and consciousness is shaped by the social and material circumstances people exist in. In effect he was arguing that what passes for our beliefs about what human nature is, cannot escape the logics embedded in the dominant forms of economic and therefore social organisation that we exist in (Garrido, 2022).

The Marxist theory of ‘base’ and ‘superstructure’ helps to further illuminate how this works within complex societal structures. ‘Base’ refers to the production forces that generate the goods society needs and ‘superstructure’ describes all other aspects of society (Marx, 1859).

Italian Marxist philosopher, journalist, and politician Antonio Gramsci, who was imprisoned in 1926 by the fascist regime of Benito Mussolini (where he remained until his death in 1937), wrote more than 30 notebooks during his time in prison. In these prison notes he explained how states can ‘manufacture consent’, shaping ideas and beliefs – in other words how societal superstructures represent and reproduce the interests of the ruling class. ‘Hegemony’ (being the strongest and most powerful and therefore able to control others) was reproduced in cultural life through the media, universities, religious, and political institutions. These then create legitimacy for the ruling classes. Hegemony gives those in power access to the main sources of influence that convince ‘the masses’ that the way the society is run is the way it should be (Hoare and Sperber, 2015). This means that how we imagine what it means to be human, and how a society should operate, emerge out of the economic and therefore political power structures that reflect the best interests of those with class privilege.

This superstructure means that institutions in capitalist societies will generally respond to, cater for, and gratify, the needs of the class that dominates the economy – the capitalist/oligarch class. The legal, political, and ideological character of that society will primarily serve those interests. All institutions that become widespread will have to be absorbed as part of that superstructure and have concordance with its ideological basis, to become mainstream. Any institution that resists will struggle, be demonised, or wither away for lack of funds, particularly if there is not an organised and mass supported social and political movement behind it.

Thus, in order to understand how we imagine – how we social construct – human nature (and therefore what we consider to be problems or disorders in that human nature), we need to examine the principles of social relations under capitalism and the tensions and contradiction present in the concrete material reality of those societies at any moment in time.

Living under capitalism

Capitalism at its core is an economic and political system in which a country’s finances, trade and industry are controlled by private owners in order to extract profit. This owner class is driven primarily by self interest in order for their enterprise to succeed. It requires the masses (the working class) to apportion a quantity of the profit their labour has produced to this owner class, thus creating the primary contradiction that drives the economic system (the more profit can be extracted from the working classes the richer the Oligarch class is and vice versa). In late-stage capitalism that we are now living in, these privatised market forces are freed to govern all aspects of societal functioning including institutions previously owned, regulated, or managed by the state.

Central to the capitalist conception of human nature is a Darwinian-like competition for resources where the ‘fittest’ wins. Citizens in a capitalist society are said to engage in a competitive field where the most talented will be the most successful (a meritocracy). Their success will be measured through their accumulation of wealth. Differing wealth strata can then be conceptualised as the outcome of the ‘natural’ tendency of humans to compete, with the ‘cream’ rising to the top.

In this model a hyper-individualism is promoted, where people are encouraged to implicitly view themselves as if they were a ‘mini business’ with a ‘brand’ that needs to stand out in some unique way and where they must triumph over others around them in the social jungle. It is a vision of human nature that’s primarily orientated to serve selfish needs and where democratic choices are best exercised through consumerist edicts of purchasing preferences. A creeping alienation from each other develops as our instinct to socially connect is reshaped as a vehicle to gain advantage. A degree of distrust and paranoia pervades relationships as we silently compare our social status to those around us, wondering where we stand and how others perceive us.

Competition is considered a key economic driver and so becomes a prominent social and cultural value (even though the growth of monopolies in late-stage capitalism creates mafia-like cartels rather than competition). Many are then subject to the ongoing fear of falling behind and becoming defined (and/or self-defined) as being a member of a class of ‘losers’. To live in a social scenario where you perceive that you are in the loser class and where this is individualised is obviously painful. Capitalism, however, has commodities to sell to help you deal with this.

Defining people as ‘vulnerable’ or ‘ill’ allows marketisation and exploitation of the ensuing mental pain, insecurity, and/or disappointment. Childhood, parenting, mood, stress, and professional approaches to intervening in these, all become subjects of commodification (the act of turning something into an item that can be bought and sold). Human suffering that follows from the pressures inequalities puts on people’s material and psychological well-being, are turned into opportunities to create individualised explanations and treatments. The growth of this commodification contributes to both an increase in certain mental problems and the continual expansion of the repertoire of behaviours and emotional states considered to be ‘abnormal’ (and therefore in need of correcting and treating with this or that product) or a sign of some valorised difference. ‘Scientism’ is used to sell brands with an aura of being scientific, so that the actual science is buried underneath the power of the profit motive.

More collectivist values such as duty, compassion, and solidarity are brought forth only if they give you some sort of advantage in the people market. As we become image (brand) conscious we are enticed into an ongoing search for self-improvement. In today’s world you must learn how to ‘sell yourself’. Not only the macro-economy but everyday relationships become regulated by a version of market logic, where a sense that you are failing, or could fail at any moment, is hard to escape.

These social forces become drivers of self-doubt, insecurity, judgementalism and shame. They are further exacerbated by the stark visibility of the growing material inequality in the societies we live in. A belief in meritocracy means that any failure is deemed a personal failure. According to Pickett and Wilkinson increasing inequality heightens social threat and status anxiety, evoking feelings of shame, which feed into our instincts for withdrawal, submission, and subordination. When the social pyramid gets higher and steeper, status insecurity increases (Pickett and Wilkinson, 2010).

From transport to schools the dominant ideology is that competition will improve standards. The value of competition will then percolate down from the staff to the customers of those institutions. This pressure to perform thus invades all strata of contemporary life. From corporate management to academic practices, from image to games, performance has become central. Knowledge is produced through measuring a system’s (and by extension an individual’s) performance – be it organisational, cultural, or technological. Institutions and individuals are subject to on-going surveillance and monitoring of their accomplishments using surrogate measures of efficiency – from exam results and school league tables to work appraisals and stock market share values. Knowledge and power are thus created through the production of competitive performance related information (Timimi, 2025).

The effect of absorbing this ideology is to privatise individuals to the degree where obligations to others and harmony with the wider community can become obstacles rather than objectives. In this ‘look after number one’ value system, other individuals are there to be competed against as they too chase after their personal desires. Figuring out who is the top dog in what, and once achieved how to stay there, is more defining of personhood than how we support each other.

When you get feelings of insecurity, anxiety, and stress and ‘epidemics’ of self-harm, eating disorders, depression, loneliness, and social phobia, these are simply the disorders of individuals with ‘dysfunctions’. They are medical conditions that arise from internal failings and that require health professionals to correct. They are most certainly not the outcome of the ‘winner’ and ‘loser’ social structure.

Even the successful can’t escape the edict to perform well. The entrepreneurial individual is often regarded as someone who can take risks. But if you don’t succeed, or if you succeed and then fail, or if you succeed but can’t seem to find a sense of contentment, or if you never feel like you’ve done enough succeeding – well, it may be because you have a disorder (like Attention Deficit Hyperactivity Disorder – ADHD) that has ‘caused’ these disappointments. It’s certainly not because this a system designed to disavow contentment. Capitalism needs a degree of chaos and performance anxiety.

Capitalism doesn’t just shape how we work or spend our money; it infiltrates the way we think about everything. It’s a system that not only fails to prioritise the common good but actively resists any attempt to fix glaring dysfunctions of society if there isn’t profit to be made.

Extreme wealth alongside extreme poverty is the inevitable outcome, both within a society and between countries. When one source of profit extraction is drying up a new one must be found. This means creating new streams of profit extraction to sustain the system. As sources dry up and the global capitalist imperial hegemony weakens, more aggressive pursuance of new opportunities develops. The post second world war so-called ‘welfare capitalism’ that brought some benefits to the working masses in order to stave off the rising popularity of socialism, are undone as we return to hyper-exploitation models with governments doubling down on austerity for the masses and tax breaks for the rich. A form of disaster capitalism emerges as the distress so produced itself becomes a novel source of profit extraction by commodifying that distress using the tools of make-belief pseudo-science.

As capitalism decays our media, our educational institutions, and so-called experts, all work tirelessly to isolate every issue into its own little bubble. Housing crisis? That’s just a matter of supply and demand. Big Pharma price gouging? A few bad actors ruining an otherwise fine system. Climate catastrophe? Something that can be solved by creating ‘green’ markets. Each problem is treated as if it exists in a vacuum, as if it’s an isolated incident with no larger pattern or systemic cause.

This deliberate compartmentalisation is no accident. The narrative that we live in a functional democracy where individual effort is rewarded, and systemic failures are unfortunate but fixable anomalies, has to be maintained. By commodifying distress and difference, the wider systemic drivers recede and instead individualised ‘treatment’ or identities are offered as solutions.

Commodification distances people from a more considered and systemic understanding of the problems being experienced. It also disconnects people from the possibility that they already possess the knowledge to know how to deal with their subjective states. Instead, you’re encouraged to buy expert/technically developed commodities, such as particular diagnoses, medications, psychotherapies, apps, courses etc., which you’re led to believe will enhance your quality of life with little adverse effects. The time and relational support needed to learn how to bear and work through emotional pain, is at risk of disappearing under such consumerist excess.

Once this system is set in motion, we can predict several things will happen. Commodities tend to give only temporary experiences of satisfaction as markets must keep selling to keep the monetary flow going and so must keep convincing consumers that there is a better product available. They must also be taught that if they stop consuming the brand (e.g., renounce a diagnosis or stop a medicine) their life would deteriorate. Once an area of life has been subject to market commodification, it will grow in volume as the pressure to make profit continues.

Thus far I have shown that the rise of prevalence of mental health conditions is occurring at the same time as the rise in consumption of Individualised treatments of dubious efficacy, within the context of a society whose value systems promotes a winner/loser performance dynamic. Why is this dynamic getting worse?

An empire in decline

In the last decade it has become clearer that the Western economic, cultural and military empire is in decline. We are experiencing a crisis of economy (cost of living, hardship and insecurity, particularly for young people) alongside a crisis of legitimacy (few believe our politicians know what to do to get us out of this cycle of decay). This has proved fertile ground for the building of a Mental Health Industrial Complex (MHIC) (Timimi, 2025b).

The compare and compete neo-Darwinian ‘performance’ model of human nature was strengthened by the Thatcher/Reagan governments adoption of the ‘neoliberal’ ideology of privatising everything, including most state assets, with the belief that self-interest creates the most efficient society. The triumph of this logic is echoed by Thatcher’s famous answer when asked what she considered as her greatest achievement and she answered, “Tony Blair”. Class politics was no longer where left/right discourse landed. Francis Fukuyama (1992) announced the end of history and what remained for (a now pseudo) left to argue was for better representation of different groups in the upper echelons of society. Identity politics, an extension of the hyper-individualism of neoliberal capitalism, argued for reform rather than any fundamental shift in the political and economic power structures in our rapidly deindustrialising and increasingly financialising centres of capital. MHIC was perfectly placed to carry out a supporting role in this new dynamic.

Despite Fukuyama’s predictions, we can see around us, whether you agree or not with the rising powers, that history did not end. Western globally hegemony is diminishing, though not without causing extensive death and brutality in many parts of the world (such as West Asia, Ukraine, and Latin America). In the decaying body of capitalism, a fake answer to the immiseration it has caused is sold back to us through MHIC and identity politics. Fight for this group or that group’s rights. If you’re distressed it may be because you are disordered, have a dysfunctioning brain, or you were born with an ‘atypical’ nervous system. Identify this and intervene early so you can get the right ‘diagnosis’ and ‘treatment’. Welcome to MHIC. You are your ‘disorder.’

The neurodiversity movement emerges in the last two to three decades ostensibly to push back against the idea that the growing numbers being diagnosed with conditions like ADHD and Autism Spectrum Disorder (ASD) have a medical condition. Instead, proponents of the neurodiversity paradigm claim that ADHD and ASD (for example) are not dysfunctions but natural variations and campaign for those diagnosed to be empowered to speak about their lives and achieve a type of ‘protected characteristic’ status. Neurodivergent campaigners compare their advocacy with gay rights or anti-racist activism, thus attempt to straddle the identity politics/mental health divide. This movement has now been incorporated into mainstream thinking and service planning, with multiple institutions from mental health and education to official guidelines and academia, having adopted their ideological position.

Whether intentionally or not, proponents of neurodiversity support biological culpability – in other words the belief (despite the lack of evidence to enable such a division) that there are identifiable neuronal differences between those deemed to be ‘neurodivergent’ and the rest who are ‘neurotypical’. This reinforces the notion that body/mind (i.e., something internal to the biology of the individual) is a primary site of difficulties fitting in with broader societal pressures. As with identity politics writ large it is thus reformist (advocating for more inclusion in the current economic system), rather than revolutionary (changing the class based economic structures – such as the power of the financial sector to dictate government policy). It therefore poses no existential threat to the ruling oligarch capitalist class.

We can see this crossing of the Rubicon from a mental health condition to identity politics in many other examples. One emotionally charged area which illustrates this process is gender identity. The desire to change your sex was so rare that in the first decade and a half of my career I only saw two young people who wanted to transition – both were male (wanting to become female), both had a troubled family history, and both eventually decided they were homosexual rather than wanting to complete a sex change. In recent years I have seen a boom in those who wish to transition. Now they are mainly females who want to become male and numbers have expanded dramatically. Most also have troubled family histories. Transgender issues now stretch out of the consulting room and into the body politic where it becomes one of the most visceral (and at times vicious in both directions) representations of the culture wars that has stalked our societies (Timimi, 2025).

All this reflects the increasing power and influence of MHIC. MHIC offers a growing variety of brands (that we mistakenly call psychiatric diagnoses) with associated products as states of emotional distress, insecurity, and pessimism about the future has spread. It allows for socio-economic problems to move from societal problems for politicians to tackle into problems between the ears that individuals must try to resolve – a welcome (for our rulers) pathway for dissatisfaction to be funnelled.

Conclusion

In the shadow of decaying economic and political imperial capitalism, new monsters are born. Soft power of superstructure institutions and practices draws energy out of the rising tide of anger, alienation, and despondency, and funnels it into isolated single issue commodified rebellions, identity politics, and fake revolutions. MHIC combines paternalistic sympathy for victims, whilst disempowering and depoliticising their suffering. Class consciousness is eroded, profitability is created. Left politics is defenestrated by promotion of a purity fetish that leaves populations in the West believing that alternatives to existing capitalism would be even worse (Garrido, 2023; Losurdo, 2017).

For MHIC to become so dominant, and its beliefs so widespread, despite the lack of scientific support or lasting positive outcomes, means that in MHIC we are dealing with a classic example of a capitalist superstructure. MHIC could not have dug so deeply into everyday consciousness if it was not enormously helpful to maintaining the ruling class’s economic and cultural dominance.

It may be that uncoupling mental health care from the dominance of the pseudo-science of the bio-medical model cannot be more comprehensively achieved until the Western capitalist empire has disintegrated, and even then, there will be a struggle to fully de-toxify from the damage it has caused. In the meantime, raising awareness of the entanglement of a failed mental health system with a failing economic/political system, where both implicitly promote hierarchical and individualised models of human nature, is necessary. In addition, it’s always worth remembering that every system has loopholes and exceptions. As I have outlined elsewhere there are many examples, both theoretical and practice-based of viable and successful alternatives to current dominant mainstream practice (Timimi, 2025).

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About the author

Sami Timimi is a child and adolescent psychiatrist and psychotherapist based in the UK. He writes and speaks extensively from a critical psychiatry perspective on topics relating to children’s mental health, psychotherapy, cross-cultural psychiatry, and the critique of psychiatric diagnoses. He is the author of several books, including Searching for Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity (Penguin Random House, 2025), Insane Medicine (2021), and co-author/co-editor of works such as The Myth of Autism and Liberatory Psychiatry. A long-standing contributor to debates challenging the medicalisation of distress, he has published over 150 articles and book chapters in the field.