Britain on the Couch: Why We're Unhappier Compared With 1950 Despite Being Richer — A Treatment for the Low-Serotonin Society

  • Oliver James
Century: 1997402Pp. £16.99.

Two subtitles maketh a reviewer's job easier. And should one miss the quasi-eighteenth-century prolixity of the title page, the opening lines also summarize the argument: “The premise of this book is that we are unhappier compared with 1950⃛ that people who are unhappy tend to have low levels of serotonin and that levels thereof are largely caused by our social psychological environment.”

Then follows a rambling mishmash of reviews of published research (always with hundreds of studies, thousands of subjects and unanimity of scientific interpretation), supplemented by case-histories from the author's experience, or his television documentaries, or secondary analysis of dysfunctionality in the British royal family. Only the latter, coupled with refreshing references to British rather than US television, justifies “Britain” in the title. As worldwide sales must be reduced, and the scientific evidence is international, I wondered about parallel editions for other countries — say, Albania on the Couch, detailing dysfunctionality in King Zog's descendants?

James's main argument is that we (“This book is about⃛ people like us”) are now more depressed (as well as anxious, phobic, obsessional, anorectic, bulimic, gambling-addicted, violent, paranoid, alcoholic, drug-hooked and sexually promiscuous) than in 1950, the common denominator being reduced brain serotonin (present mainly as metaphor rather than molecule). Society has changed since 1950, becoming more competitive, less certain and less predictable. We know more about other people, and compare ourselves more, often with high-profile media-inflated role models, and find ourselves wanting. And a war between the sexes (“gender rancour” in James's quaint phrase), with less well-defined roles, increases divorce and disrupts childhood. This potent mixture makes naked apes, recently out of Africa, more depressed (and anxious, and so on). Is this plausible?

The book's argument depends critically on depression being more common now than half a century ago. Two other current controversies indicate the methodological problems. Is childhood asthma truly increasing, or is there just increased willingness to report symptoms or make diagnoses? Has intelligence really increased this century (scores on identical tests are certainly higher), or is there just increased impulsivity, test-wiseness, guessing or visual literacy?

For psychiatry the problems are much greater. Standardized instruments such as the General Health Questionnaire now routinely use higher cut-offs for ‘caseness’, as people more willingly acknowledge problems. Historical studies of depression have not used equivalent criteria. James's brief appendix on “the scientific evidence” depends almost entirely on retrospective self-diagnoses in Klerman's controversial study of subjects of different ages. Even if depression has increased, proving causation is even more problematic; we see what we want to see, particularly when social and political factors are involved.

The final chapters give James's prescriptions for raising our low serotonin levels. Twenty million of the UK population would benefit from that contemporary soma Prozac (despite the claimed low libido, erectile failure or anorgasmia in 30-70 per cent of users). Psychotherapy and a more collectivist, communitarian “advanced capitalism” would also help.

Neither is diet neglected, with a serotonin-boosting recipe reminiscent of George Bernard Shaw's crankiness: “One approach is to consume only the juice extracted from pears, sweet beetroot⃛ and carrots, from a juice extractor for a period of three days every month, consuming as many apples as are required if hungry in the interim.” Surpisingly, James — unlike G. B. S. — doesn't tell us to stimulate the phagocytes.