David Smail

David Smail (1938–2014) was a British clinical psychologist who spent many years working in the National Health Service and practised in clinical psychology in Nottingham. His professional experience with patients suffering from anxiety, depression and frustration led him to ask whether psychological distress can be treated merely as a personal problem to be resolved in the consulting room.

In works such as Illusion and Reality: The Meaning of Anxiety (1984), Taking Care: An Alternative to Therapy (1987), The Origins of Unhappiness (1993) and How to Survive Without Psychotherapy (1996), he argued that psychological distress arises above all from external pressures, including poverty, inequality, powerlessness, humiliation, and insecurity at work and in the family. In his view, conventional psychotherapy, by focusing on the individual's "inner world", overlooks these social roots and at times holds patients responsible for suffering they did not create.

In Power, Interest and Psychology (2005), Smail set out his position as a theoretical framework, a social materialist understanding of psychological distress. Drawing on intellectual traditions such as those of Marx and Foucault, he sought to show how power and social interests shape people's psychological experience.

Even so, Smail did not dismiss therapy entirely. He stressed empathy, care and a realistic view of the patient, and held that genuine help must go hand in hand with an understanding of the patient's living conditions. His work is significant for critical psychology and for the critique of the medicalization of suffering.