Sanity's shining light

Emotional distress is a form of dissent, a signal that we need to rethink how society operates
Christmas No 1s are usually mawkish nonsense, but in 2003 it was the song Mad World. With the chilling line "The dreams in which I'm dying are the best I've ever had", in some respects it is up there with TS Eliot's Prufrock as a poetic account of bourgeois despair.

From Erich Fromm to RD Laing, authors have rightly asserted that the more well adapted you are to our crazy society, the crazier you will be. Yet the light of sanity still comes shining through. As a friend of mine recently pointed out, the really interesting question is: "Given what we know [of the personal and geopolitical lunacy of our leaders], how come the world is so good?" A telling example of how truth prevails against the odds is a new study of attitudes to causes of mental illness.

For decades, psychiatrists have explained to people who are feeling like shit that they have "an illness like any other illness - you would let me put your broken leg in a cast, why not let me treat your physical problem of depression/schizophrenia/anxiety, caused as it is by abnormal brain chemistry, itself caused by genes, with a pill?". Yet we see this misinformation for what it is.

Summarising 53 surveys from 17 nations, John Read demonstrates (in the journal Acta Psychiatrica Scandinavica) that the public almost everywhere continues to believe that schizophrenia is more likely to be caused by environment than by genes or by deviant brain chemistry, pinpointing childhood maltreatment, poverty, recent traumas and bereavements. The same is true for other "mental illnesses".

Read concludes that "the public may have a better grasp of the causes than some of us mental health experts. All the social causes they cite have recently been substantiated." Indeed, Read's book Models of Madness demonstrates that at least half of the people diagnosed with schizophrenia suffered severe sexual or physical abuse, and that poverty and urban living are independent causes.

Through their unwitting lapdogs - the psychiatric establishment and geneticists - drug companies teach that emotional distress is a chemical destiny only alterable by pills. But in a sane world, while drugs are sometimes necessary in emergencies, they would hardly ever be used for more than a few months. Instead, there would be a massive effort by government to create a society that is not craziness-inducing and that provides talking cures for those already damaged by it.

Regarding prevention, the strongest clue is that pre-industrial, traditional communities have far lower rates of emotional distress. Just as ecological logic demands a shift away from materialism if we are to survive, so mental health requires us to rethink industrialisation and urbanisation - the fundamental causes of mental illness.

Regarding talking therapies, just think what could be done with £20bn spent on therapy and prevention. I am not talking about Richard Layard's proposal to spread a thin layer of cognitive behaviour therapy (CBT) across the land, which could be as damaging as taking pills. All too often, CBT tutors the patient to tell a relentlessly positive story, to ignore many of their true feelings, just as drugs do. Not surprisingly, the studies show that once the teacher is no longer there, the depressed or anxious truth of our crazy world reasserts itself within a few months.

CBT comes from a stable of psychology that deems accurate negative thoughts about oneself as "depressive realism", and health as living in a rose-tinted bubble of positive illusions. For, truly, emotional distress is a form of dissent - an important signal that early family experiences and adult society have been or are distressing.

What we urgently require is £20bn devoted to a Campaign for Real Therapy. It would closely examine what the best short-term methods, such as the Hoffman Process or cognitive analytic therapy, are good for, and what longer-term interventions can achieve when properly focused and modified.

Sanity is a much more useful notion than illness - emotional maturity should be the goal, not happiness. A precursor to the Mad World ditty was David Bowie's Cygnet Committee (on Space Oddity). It builds up to the lines "I want to believe in the madness they call now, and I want to believe that a light's shining through somehow ... and we want to believe, and we want to live."

Despite all the darkness and lies, unlike the lunatics who rule us, we know that life is sweet and that sanity can prevail.

· Oliver James's book Affluenza will be published in January