PSYCHO-ECONOMIC IMPERIALISM =
the chemical colonisation of young minds by the use of psychoactive drugs to generate the profitability of BIG PHARMA and its shareholders and for social control.(Dave Traxson 2013)
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| NEUROECONOMICS |
Psychiatric
Imperialism:
The Medicalisation of Modern Living
Introduction
The institution of psychiatry grew up in the 19th
century during the emergence and consolidation of industrial capitalism. Its
function was to deal with abnormal and bizarre behaviour which, without
breaking the law, did not comply with the demands of the new social and
economic order. Its association with medicine concealed this political function
of social control by endowing it with the objectivity and neutrality of
science. The medical model of mental disorder has served ever since to obscure
the social processes that produce and define deviance by locating problems in
individual biology. This obsfucation lends itself to the perpetuation of the
established order by side-stepping the challenge that is implicit in deviant
behaviour and thereby undermining a source of criticism and opposition. During
the 20th century, a fierce attack on psychiatry has condemned this misleading
medical characterisation of the problems of living and the repressive measures
that masquerade as psychiatric treatment. However, at the same time more
sophisticated technology has enabled the psychiatric profession not only to
weather the storm, but to strengthen its claim to the jurisdiction of 'mental
illness.' Opportunities for social control and the suppression of dissent in
the guise of psychiatry have increased.
In some respects psychiatry has never been as
confident and respectable as it is at present. In the 1950s and 1960s a
pharmacological revolution produced an array of drugs for use in disorders such
as schizophrenia, depression and anxiety which enabled psychiatry to move closer
to the paradigm of physical medicine of administering specific cures for
specific conditions. Starting in this period also, psychiatric care relocated
physically away from the discredited asylums and into general hospitals, in
closer proximity to the rest of the medical community. This move embodied the
attempts of the psychiatric profession to disentangle itself from the stigma of
caring for the chronically insane and instead to forge a role curing the
acutely disturbed. Community care is the concession to the chronic and
recurrent nature of psychiatric conditions.
Similarly, the endeavour to locate the biological
origins of mental illness has been revitalised by the introduction of new
technology for studying the brain and by the development of molecular genetics
and the human genome project. Despite a disappointing lack of consistent
results, the quantity of resources devoted to this research has, in itself,
leant the medical model of mental illness further credibility.
However, the 20th century has also produced an
influential critique of psychiatry articulated by academics and some rebel
psychiatrists (famously, R.D. Laing, Thomas Szasz & David Cooper).
Sociological theories of deviance, medicalisation and the organisation of
professions helped to expose the political functions and processes involved in
the institution of psychiatry. The paternalism of psychiatry was attacked and
medical treatment was accused of being more oppressive than legal sanctions or
punishment.
These ideas were expressed in concrete form in the
activities of protest movements, patient advocacy groups and experiments in
alternative care. In the early 1970s in the Netherlands and the United States,
where protest movements were particularly strong, there were demonstrations
against the use of electro convulsive therapy (ECT), university lectures were
disrupted and some prominent biological psychiatrists had to have police
protection. There were famous attempts to create therapeutic communities which
renounced staff patient distinctions and hierarchies (such as R.D. Laing's
Kingsley Hall and David Cooper's Ward 21in the United Kingdom) and in Italy a
politically conscious democratic psychiatry movement instituted mental health
care reforms. The patient advocacy movement, which took inspiration from civil
rights organisations, was another important development. Although the activism
has diminished, patient or survivor groups remain strong and individuals and
groups of professionals continue to promote alternative approaches to the problems
of the so-called mentally ill . The 'antipsychiatry' movement also had a
significant impact on social policy resulting in increasing restrictions on
involuntary confinement and treatment and a diminishing use of physical
techniques such as psychosurgery and ECT.
However, recent developments in the definition and
management of two major psychiatric conditions, depression and schizophrenia,
illustrate that the social influence and formal powers of institutional
psychiatry may now be expanding. The criticism that was first expressed over
three decades ago may therefore be more relevant than ever.
Depression: medicalising discontent
The Defeat Depression Campaign (DDC), launched in
1992 was organised by the Royal College of Psychiatrists in association with
the Royal College of General Practitioners with funding from the pharmaceutical
industry. The literature of this campaign suggests that around 10% of the
population suffer from a depressive disorder at any one time, a third will
suffer at some time during their lives and antidepressant drugs are recommended
for all those with moderate to severe symptoms. These claims seem to suggest
that a large proportion of human unhappiness is biologically based and can be
similarly corrected. The publicity surrounding the new antidepressant
fluoxetine (prozac) has become only slightly more extreme with claims that it
has personality altering and general life enhancing properties.
A recent collection of interviews with prominent
psychopharmacologists who were involved with the discovery and introduction of
modern psychiatric drugs provides an interesting historical backdrop to the
DDC. In psychiatric hospital practise in the 1950s depression was a relatively
rare disorder and there was no concept of a specifically antidepressant drug as
opposed to a general stimulant. When antidepressant action of certain compounds
was first proposed drug companies were initially reluctant to develop and
launch such drugs. In an unconscious alliance of interests, influential
psychiatrists developed and popularised the view of depression as a common
biologically based disorder, amenable to drug treatment and as yet frequently
unrecognised. This concept had the dual benefits of vastly expanding the market
for psychiatric drugs and extending the boundaries of psychiatry outside the
asylum. Since this time the psychiatric profession and the drug industry have
continued to try and inculcate this idea into the consciousness of both the
general public and other doctors. The DDC is the latest offensive.
Numerous biochemical mechanisms responsible for
depressive illness have been proposed implicating a variety of biochemical and
hormonal mechanisms, partly determined by fashion. The evidence for all these
theories has been inconsistent and the consensus about the efficacy of
antidepressant drugs remains the strongest support for the thesis that
depression is a physiological condition. Perusing the psychiatric literature
indicates that this consensus developed in the mid 1970s based on evidence from
randomised controlled trials of the original and still widely used
antidepressants, the tricyclics. However, early reviews of this evidence
portray an ambiguous situation with a large proportion of trials failing to
find a positive effect. In addition, more recently some researchers have
suggested that antidepressants are not specifically active against depression
but merely exert a placebo effect in a receptive condition. They appear to
perform better than an inert placebo because their side effects increase their
suggestive power and may admit bias into the assessment procedure by enabling
investigators to guess whether patients are on the active drug or the placebo.
A recent meta-analysis of placebo controlled trials of prozac found that the
likelihood of recovery was indeed associated with experiencing side effects . A
review of seven studies which used an active substance as a placebo to mimic
antidepressant side effects found that only one showed the drug to be superior.
Variation in mood is a characteristically human way
of responding to circumstances but unhappiness has become taboo in the late
20th century, perhaps because it undermines the image that society wishes to
project. Medicalisation diminishes the legitimacy of grief and discontent and
therefore reduces the repertoire of acceptable human responses to events and
denies people the opportunity to indulge their feelings. At the same time it
diverts attention away from the political and environmental factors that can
make modern life so difficult and distressing. It may be no co-incidence that
the concept of depression has reached its present peak of popularity in western
societies reeling from two decades of economic events and political policies
which have been blamed for increased unemployment and marginalisation of a
substantial section of the population.
However, it is also important to acknowledge that
people have different propensities to experience intense moods and that, for those
at the extremes of this spectrum, such as those with manic depressive disorder,
life can be very difficult. Prophylactic medication is promoted by
psychiatrists for long-term use in this condition primarily in the form of
lithium. However, in a similar way to antidepressants, claims of the efficacy
of lithium seem to have been based on insubstantial evidence and follow up
studies of people with manic depression do not indicate that it has improved
the outlook of the condition. It is possible therefore that prophylactic drug
treatment constitutes a false hope held out to people who feel desperate, by a
profession that feels helpless. But it may only further undermine the self
assurance of people who are already vulnerable. Instead of aspiring to complete
cure, natural remission of episodes should be encouraged by providing care and
security, and attempts should be made to enhance people's confidence in their
own ability to manage or survive their condition.
Schizophrenia: disguising social control
The enormous investment in the investigation of the
biological basis of schizophrenia has produced no conclusive information.
Decades of increasingly sophisticated technological research has revealed a
possible weak genetic predisposition, often much exaggerated by psychiatric
commentators who ignore the shortcomings of the main studies . Molecular
genetic studies have publicised initial findings implicating several different
genes which then transpired to be due to chance when attempts at replication
failed. The most recent pan European study boldly concludes that the genetic
associations revealed are involved in the pathogenesis of the disorder.
However, the gene implicated is common in the general population, it is only
slightly more common in people diagnosed with schizophrenia and the similarity
of the comparison group in this study was ensured only for ethnicity and not
for other factors. As regards brain function and anatomy, the only consistent
finding is the larger size of the lateral ventricle, one of the brain cavities,
in people with schizophrenia. Again there is a substantial overlap with the
'normal' population and most studies have been conducted on people with long
histories of drug treatment. However, the possibility that drugs may be
responsible for causing the brain abnormalities observed has received little
attention in the psychiatric literature .
Drugs variously termed 'major tranquillisers,'
'neuroleptics' or 'antipsychotics' form the mainstay of psychiatric treatment
for schizophrenia. They have been claimed to have specific action against
psychotic symptoms such as delusions and hallucinations, but critics suggest
that they act in a much cruder way by producing a chemical lobotomy or straight
jacket which inhibits all creative thought processes . Psychiatry applauds the
role of these drugs in emptying the asylums but an alternative perspective
suggests that they merely helped to replace expensive custodial care with
long-term drug-induced control.
A consequence of the move towards community care is
that public and political anxiety has replaced the concern for patients rights
with concern for protection of the community and psychiatric treatment has
become the panacea for this complex social problem. In response to a few highly
publicised cases of violent or dangerous acts by former psychiatric patients,
amendments were made to the Mental Health Act (1983) which came into force in
April 1996 and which introduce a power of 'supervised discharge.' This power
enables psychiatric personnel to have access to the patient if deemed necessary
and to enforce attendance at psychiatric facilities. It does not confer the
right to enforce medical treatment but it does require that an assessment for
admission to hospital be conducted if the patient is uncompliant with aftercare
arrangements such as refusing medication. The justification for this
legislation is the assumption that medical treatment can cure disturbance and
prevent relapse. However the evidence indicates that a substantial proportion
of people with a psychotic episode fail to respond to medication at all, a
further significant proportion relapse despite taking long-term medication (in
clinical trials the relapse rates on medication is around 30%) and, like other
people, they may behave antisocially when they are not actively psychotic.
The social control element of the changes to the
Mental Health Act is only thinly veiled and they have been strongly opposed by
civil and patients rights groups. Their significance lies in the introduction
of a new precedent of control over people after discharge from hospital. The
use of the former 1983 Mental Health Act for these purposes was successfully
challenged in the courts in the 1980s. The exact form of the new provisions
when implemented is uncertain and is likely to vary according to the
predisposition of local professionals. Although there is much unease among
psychiatrists about shouldering increased responsibility for the actions of
people labelled mentally ill, many in the profession have called for stronger
powers to enforce medical treatment in the community.
The medical model of mental illness has facilitated
the move towards greater restriction by cloaking it under the mantle of
treatment. This process of medicalisation of deviant behaviour conceals complex
political issues about the tolerance of diversity, the control of disruptive
behaviour and the management of dependency. It enables a society that professes
liberal values and individualism to impose and reinforce conformity. It
disguises the economics of a system in which human labour is valued only for
the profit it can generate, marginalising all those who are not fit or not
willing to be so exploited.
Characterisation of schizophrenia as a physically
based disease of the brain also forecloses any debate about the meaning of the
experiences and actions associated with it. Attempts to render schizophrenic
symptoms intelligible and to understand their communicative value help both to
illuminate ordinary experience and to increase empathy for people with this
condition. Other interesting findings point to the association of schizophrenia
with features of social structure. Nothing resembling schizophrenia was
described prior to the early 19th century, suggesting an association with the
emergence of industrial capitalism. In modern societies schizophrenia is more
frequently diagnosed in urban centres, among people of lower social class and
in certain immigrant groups when compared to their country of origin,
particularly second generation afro-Caribbean people in the UK. Research in the
third world has shown that people with schizophrenia have a better prognosis
with a lower chance of relapse and functional decline than their counterparts
in the developed world . It appears therefore that social conditions play a
part in determining the expression of schizophrenic symptoms and so
schizophrenia may be regarded as a mirror on the deficiencies of the current
social structure.
Tolerance of the diversity of human lives and a
respect for the autonomy of all must be the foundation of a progressive
alternative approach. Enhancing people's control over their lives means
providing genuine choices and opportunities for people of all different
propensities. It means creating a society where there are niches available that
allow a diversity of lifestyles. It involves accepting that some people may
chose to lead lives that appear bizarre or impoverished. Although some people
with schizophrenia will find drug treatment useful, psychiatrists frequent
complaints about non compliance illustrate that many chose not to take
medication. Similarly, some people with chronic mental illness gravitate away
from the structured, rehabilitating environment of the mental health services
to homeless hostels and to the streets. It is commonplace to blame the
underfunding of community care for this phenomena but research has found that
most of the homeless psychiatrically ill had not come straight from closing
hospitals but had been settled in adequate community accommodation before
drifting away . An alternative explanation might be that the long-term mentally
ill prefer the undemanding nature of the homeless situation to the intrusive
demands of family, community and mental health services.
The management of disruptive and dangerous
behaviour is a problem for every society. Involuntary confinement and treatment
continue to be a major area of contention with opposition emphasising the need
to respect people's autonomy and opposing the imposition of a relative set of
values about what is normal and sane. It is argued that it should be possible
to deal with behaviour that is genuinely harming or harassing other people
using normal legal sanctions. It is an area which requires further and wider
consideration. Whatever solution is adopted, it must be developed openly
and democratically, with proper provision for representation and public
scrutiny, so that measures taken can not be subverted to serve the ends of
certain groups above others.
Conclusion
Despite the political and professional retrenchment
of recent years, there are many developments which presage the ultimate
transformation of the psychiatric system. The burgeoning patients rights
movement and the anti-psychiatry critique are some of these. Rejection of
paternalism is also embodied in the increasingly important role of consumers in
medicine in general and the demand for justification of treatments and
involvement in decision making. The medical profession is also placing more
emphasis on objective evidence about the effectiveness of procedures and
showing less inclination to support the principle of clinical freedom. Many
individual psychiatrists are aware of the political conflicts that beset their
practice and try to address these thoughtfully and with respect for their
patients and philosophical debate, which inevitable touches on political
issues, is flourishing within the profession at present. It is unlikely however
that psychiatry will be radically transformed without profound social and
political change. The control of deviance and the enforcement of conformity are
too central to the smooth functioning of the divisive and exploitative social
system in which we live.
Reprinted from Soundings, issue
6, summer 1997, published by Lawrence and Wishart, London.
I am a
Senior Lecturer in Psychiatry at University College London, department of
Psychiatry and Behavioural Science. I have published several critical reviews
of psychiatric drug treatments, as well as papers on the history of psychiatry.
I am a founder member and co chair person of the Critical Psychiatry Network
(web site: www.critpsynet.freeuk.com). This is a network of psychiatrists in
the UK who challenge some of the orthodox thinking in psychiatry, especially
the emphasis on the medical model of psychiatric disorder, and the link between
psychiatry and coercion.
Psychiatric drug promotion and the politics of neoliberalism
- JOANNA MONCRIEFF, MBBS, BMedSci, MSc, MD
- Department of Mental Health Sciences, University College London, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK.
- E-mail: j.moncrieff@ucl.ac.uk
Abstract
The
pharmaceutical industry has popularised the idea that many problems are caused
by imbalances in brain chemicals. This message helps to further the aims of
neoliberal economic and social policies by breeding feelings of inadequacy and
anxiety. These feelings in turn drive increasing consumption, encourage people
to accept more pressured working conditions and inhibit social and political
responses.
Editorial
Despite
the fact that objective measures show that health is improving, people in the
Western world are taking more prescription drugs than ever before. A
substantial and rising proportion of these are for mental disorders and this
has led some observers to talk of an ‘epidemic of psychological disorders’ (Hamilton, 2003). In the UK the use of
antidepressants increased by 234% in the 10 years up to 2002 (National Institute for Clinical Excellence, 2004).
In the USA 11% of women and 5% of men now take antidepressants (Stagnitti, 2005). This development has coincided
with the occurrence throughout the world of political and social trends that
are sometimes referred to as ‘neoliberalism’. I suggest that the model of
distress that underpins the promotion of psychiatric drugs may be a useful
adjunct to these policies.
Pharmaceutical
company publicity frequently refers to chemical imbalances as the putative
basis of mental disorders. For example, the following discussion can be found
on the Pfizer website (http://www.geodon.com/s_WhatCauses.asp, last
accessed 6 February 2006):
‘What
causes schizophrenia?’ ‘No one knows the exact causes of schizophrenia...
.Imbalances of certain chemicals in the brain are thought to lead to symptoms
of the illness. Medicine plays a key role in balancing these chemicals.’
The
following comments can be found on the Eli Lilly website (http://www.prozac.com/how_prozac/how_it_works.jsp?reqNavId=2.2,
last accessed 6 February 2006):
‘Depression
is not fully understood, but a growing amount of evidence supports the view
that people with depression have an imbalance of the brain’s neurotransmitters,
the chemicals that allow nerve cells in the brain to communicate with each
other. Many scientists believe that an imbalance in serotonin may be an
important factor in the development and severity of depression.’
This
idea is a popular version of the longstanding psychiatric model of mental
disorder as arising from potentially identifiable deviations from ‘ normal’
biological functioning. However, whereas traditionally this model had a
relatively limited application to severe mental disorders, the activities of
the pharmaceutical industry in recent years have greatly expanded its
application. Disease awareness campaigns for depression, social anxiety
disorder, generalised anxiety disorder, post-traumatic stress disorder,
attention-deficit hyperactivity disorder and premenstrual dysphoric disorder
have been wholly or partly funded by drug companies and they have sponsored
research into compulsive buying disorder and ‘preventive treatment’ for
psychosis. The effect of these activities has been to increase the number of
people who define themselves as psychiatrically ill and to create the
impression that the biochemical basis of psychiatric disorders is well
established (Rose, 2004). For example, the well-informed
public (e.g. specialist journalists) has been shocked to hear that research has
not established that serotonin abnormality is the cause of depression. A recent
paper demonstrates why this is so by exposing the gap between the simplistic
and confident assertions found in promotional literature (such as those quoted
above) and the inconsistent and tenuous nature of the findings of research into
the links between serotonin and depression (Lacasse & Leo, 2005).
How
is it possible that society has reached a situation in which ‘ compulsive
buying disorder’ does not seem an absurdity and academic papers can discuss its
biochemical basis (Bullock & Koran, 2003)? The answer may lie in
the convergence of the efforts of the pharmaceutical industry with wider
political interests.
Neoliberal
policies, which date from the late 1970s, are designed to facilitate the
expansion of activities of private corporations through deregulation and
privatisation. Deregulation refers to reduced state restrictions on trade,
capital flows and business practices. A massive transfer of wealth from the
public sector to the private sector has occurred worldwide since the 1980s and
with it there has been a ‘historic transfer of political authority from the
state to the private market’ (Hamilton, 2003: p. 17). In addition, the
principles of the market have been imported into the remaining public
enterprises, such as the National Health Service, to foster competition and
shape them in readiness for sale to private providers (Price et al, 1999).
Increased
commercial activity demands increased consumer spending and deregulation allows
industry to increase the levels of exploitation of its workforce. If people are
to cooperate with this situation, they must be persuaded that the system is
morally good, or at least that it is morally neutral. To this end neoliberalist
thought portrays ‘market forces’ as natural, inevitable and unrestrainable, and
as exempt from normal consideration with regard to the exploitation of people
or the environment. Therefore the guilt that would normally arise from
excessive consumption or profiteering is suppressed (Richards, 1989). In this context the values of
individualism, competition and consumerism can be praised and policies
justified by appealing to ‘efficiency’ and ‘ consumer choice’.
The
deregulation of business and the decline in state welfare provision have led to
growing inequality throughout the world, both within and between countries.
This polarisation between rich and poor has occurred rapidly and very visibly,
thanks to the increasing spread of different forms of media. For example, in
the USA in the 1980s the top 10% of the population increased their income by
16%, and the top 1% increased their income by 50%. In contrast, the bottom 10%
lost 15% of their income (Phillips, 1990). Alongside this growing
polarisation of wealth most people are working more intensely for longer hours,
and have poorer working conditions and little job security. Unemployment and
low wages are endemic, and health inequalities are growing.
Neoliberal
economic policies have been accompanied by increasingly authoritarian social
policies. Rates of imprisonment have increased steadily in many Western
countries. In the USA, 1.3% of the male population and almost 5% of the Black
male population are now in prison (Bureau of Justice, 2005). In the UK, legislation
in recent years has introduced child curfews, parenting orders and the
Anti-Social Behaviour Order (ASBO), and looks set to increase the use of
compulsion in the community for psychiatric patients. These measures can be
seen as attempts to police the consequences of economic policies by controlling
and excluding the minority of Western populations that are the victims of the
dismantling of the welfare state and the low-wage economy.
The
propagation of the chemical imbalance theory provides a more subtle means of
social control, and supports the neoliberal values of competitiveness and
consumerism. Hamilton (2003) has pointed out that the system works by
encouraging people always to be dissatisfied and to want more. He describes
modern consumers as being in a ‘permanent state of unfulfilled desire’ (Hamilton, 2003: p. 87). The chemical imbalance
theory implies that there is a normal or ideal neurochemical state against
which everyone can be measured. As the boundaries of disease are pushed out, a
large proportion of the population are encouraged to be dissatisfied with
themselves and to ‘ rectify’ the state of their brain chemistry. People are
encouraged to aspire to be something different from themselves, in their
emotional lives as well as in their material lives. Individual consumption – in
this case of pharmaceuticals – is presented as the means of achieving this.
However,
instead of bringing resolution, people are not easily satisfied, as with
material consumption. The need for medication only confirms their feelings of
inferiority and anxiety. These feelings are debilitating and they help both to
create the dissatisfaction that drives consumerist behaviour and to produce a
state of mind that is necessary for an increasingly competitive working
environment. A population that feels inadequate is more vulnerable to
manipulation by advertising and less able to resist increasing demands from
employers. Feelings of inadequacy also generate support for authoritarian
social policies and right-wing political groups (Hamilton, 2003).
Critics
of psychiatry have long pointed out that locating the source of problems in
individual biology – ‘blaming the brain’ – impedes exploration of social and
political issues. It prevents serious consideration of the way in which
economic imperatives, such as the need to tolerate poor working conditions and
the discipline of the school system, help to define certain behaviours as
pathological. It also obscures the effects of social factors, such as overwork
and increased competition, on mental well-being. If people are permanently
preoccupied with their mental health, they are less able to challenge social
conditions and to fight for alternative values. The widening application of
psychiatric disease theory by the pharmaceutical industry therefore not only
helps to expand markets for psychotropic drugs but also helps to create
conditions in which neoliberal policies can thrive and in which resistance to
them is curtailed.
However,
neoliberalism has also created opportunities and paradoxes. Consumer
participation has democratised services, increased access to information and
challenged the hegemony of professionals. Consumer groups have led the way in
criticising the pharmaceutical industry and monitoring and publicising its
activities. Examples include the Alliance for Human Research Protection (http://www.ahrp.org),
Corpwatch (http://www.corpwatch.org)
and Public Citizen (http://www.citizen.org)
in the USA, Adverse Psychiatric Reactions Information Link (http://www.april.org.uk),
Health Which (http://www.which.co.uk)
and Social Audit (http://www.socialaudit.org.uk) in the UK, and
Healthy Skepticism (http://healthyskepticism.org) in Australia. A
debate has started within medicine about the relationship of the profession
with the pharmaceutical industry but disentangling the two still has far to go.
The training of students and junior doctors needs to address both the question
of the pharmaceutical industry’s influence on research and the compromising
nature of drug-company hospitality. Doctors must also become aware of the
political implications of the current epidemic of psychotropic drug
prescribing, especially since they are well placed to help to apply the brakes.
- Received September 14, 2005.
- Revision received November 15, 2005.
- Accepted November 30, 2005.
References
Bullock, K. & Koran, L. (2003)
Psychopharmacology of compulsive buying. Drugs Today, 39, 695– 700.
Bureau of Justice (2005) Statistics,
June 2004. Washington, DC: Bureau of Justice. http://www.ojp.usdoj.gov/bjs/prisons.htm
Hamilton, C. (2003)
Growth Fetish. Crow’s Nest: Allen & Unwin.
Lacasse, J. R. & Leo, J. (2005)
Serotonin and depression: a disconnect between the advertisements and the
scientific literature. PLoS Medicine, 2, e392doi:
National Institute for Clinical Excellence (2004)
The Treatment of Depression in Primary and Secondary Care. London: NICE.
Phillips, K. (1990)
The Politics of Rich and Poor. New York: Random House.
Price, D., Pollock, A. & Shaoul, J. (1999)
How the World Trade Organisation is shaping domestic policies in health care. Lancet,
354, 1889– 1991.
Richards, B. (1989)
Visions of freedom. Free Associations, 16, 31– 42.
Rose, N. (2004) Becoming
neurochemical selves. In Biotechnology, Commerce and Civil Society (ed. N.
Stehr), pp. 89–128. New Brunswick, NJ: Transaction Publishers.
Stagnitti, M. (2005) Antidepressant
Use in the US Civilian Non-Insitutionalised Population, 2002. Statistical Brief
#77. : Rockville, MD: Medical Expenditure Panel, Agency for Healthcare
Research and Quality. http://www.meps.ahrq.gov/papers/st77/stat77.pdf
A suitable case for treatment
Once
anxiety and stress were problems. Now they are illnesses. But a backlash is
brewing. A new report says post-traumatic stress disorder is a
"non-disease", writes Chris Horrie.
Hardly a week goes by without
dramatic news of a medical breakthrough in fighting disease.
But do we actually feel
healthier? Sometimes it seems that for every illness we learn to treat, a new
malady crops up.
One of the latest is called
general anxiety disorder (GAD), and psychologists claim there are two million
sufferers in the UK alone.
But sceptics balk at the
suggestion GAD and many other "illnesses" are, in fact, medical
conditions.
Controversially, they claim that
difficulties previously explained as moral, political or social problems - or
plain bad luck - are now defined as types of mental illness.
Experts call it the
"medicalisation of human distress" - the trend to treat any sort of
human unhappiness as a form of personal psychiatric injury which may need
treatment and, almost certainly, is somebody else's fault.
The complete picture
The World Health Organisation's
definition of "health" is a state of "complete physical, mental
and social well-being". Anything less than this and you are ill.
There was even a proposal, put
forward recently in the British Medical Journal, that happiness should be
classified as a "mental disorder".
Thankfully, it was a joke,
intended to satirise the fact that what previous generations would have thought
of as simple unhappiness can now be defined as one of a range new-fangled
psychiatric conditions ranging from post-traumatic stress disorder to
post-abortion syndrome.
And then there is general anxiety
disorder, which manifests itself through worries about work problems, household
chores, lack of money and other health issues.
Researchers looking into this
condition say Piglet, the diminutive character from the Winnie the Pooh stories
who was always afraid of meeting a "Heffalump", was the classic
sufferer.
Winnie
The Pooh's Piglet was a seriously troubled individual
 |
GAD
researcher
|
Piglet was a "seriously
troubled individual", according to Canadian researchers quoted in The Sun
newspaper.
Experts say the
"medicalisation" trend has its roots in modern culture as well as
business and medicine.
In the past, people might have
blamed society for their woes and looked for political solutions. But the
"Me Generation" is more likely to seek an individual quick fix - in
the form of a pill, if at all possible.
Others blame "psychiatric
imperialism" - the alleged tendency of psychologists to push their way
into more and more areas of life.
Joanna Moncrieff, specialist
registrar in psychiatry at Chelsea and Westminster Hospital, says the 1992
Defeat Depression Campaign, launched by the Royal College of Psychiatrists, was
the start of the current boom.
The campaign, which was based on
the idea that 10% of people are suffering from depression at any given time,
came at a time when Prozac was gaining popularity.
Biological unhappiness
Pharmaceutical companies, Ms
Moncrieff said in a recent report, wanted to "suggest that a large
proportion of human unhappiness is biologically based and can similarly be
corrected".
Drug
companies want to suggest that a large proportion of human unhappiness is
biologically based and can similarly be corrected.
|
Joanne
Moncrieff
|
Medical commentator Dr James Le
Fanu also sees important commercial considerations involved in the
"medicalisation" trend.
Having failed to come up with
cures for what he describes as "serious" diseases such as cancer and
dementia, Dr Le Fanu says the pharmaceutical industry switched its attention to
what he calls "lifestyle" problems - unhappiness, obesity, baldness
and forgetfulness.
One idea, he says, is to get more
and more conditions defined as medical disorders so that drugs can be produced
and prescribed in the same way.
The drugs industry is already
marketing a drug called Xenical as a treatment for obesity and Regaine as the
answer to unhappiness caused by hair loss.
But the stance is seen as extreme
by some people at least. Critics say conditions such as depression and obesity
are more serious than "lifestyle" concerns - an estimated 15% of
those who suffer from clinical depression will attempt suicide.
In his book, The Greatest Benefit
to Mankind - The Medical History of Humanity, historian Roy Porter says
medicine has gone beyond the original passive and negative activity of healing
the sick and turned into a positive project of health promotion.
The result, he says, has been the
creation of "the therapeutic state", where almost every type of
social or political problem is seen as a type of mental illness capable of
individual therapeutic treatment.
Boom and decay
The boom in the therapy industry
has matched the decline in political involvement and the decay of many public
institutions.
The best example of the
"medicalisation" of politics, many say, is the case of
"post-abortion syndrome".
The mental condition, which was
said to lead women into specific kinds of depression after terminating a
pregnancy, was described at a psychology conference last year as an
"invention" of anti-abortion campaigners.
A major statistical study showed
no connection between abortion and the types of depression said to make up the
"syndrome". What had happened, researchers said, was that
anti-abortion campaigners, feeling that their case was not gaining enough
support, had resorted to "medicalising" the moral decisions involved.
But now a backlash may be
underway.
The current edition of the
British Medical Journal carries a withering attack on post-traumatic stress
disorder.
The illness has been the cause of
a growing number of compensation claims in recent years and is seen by many as
the clearest example of "medicalisation" of unhappiness.
Dr Derek Summerfield, of St
George's Hospital Medical School, London, criticises the "disorder",
calling it a "non-disease" which has been invented for social and
political, not psychiatric or medical reasons.
The disorder, he says, was
invented as America's way of dealing with the aftermath of defeat in the
Vietnam War in the 1970s. It was invented by critics of the war, who saw
American soldiers as psychological "victims" of the US military
establishment.
"Thus the misery and horror
of war is reduced to a technical issue tailored to Western approaches to mental
health," Dr Summerfield says.
Unpleasant but ordinary
At the same time, he adds, there
has been a "conflation" of distress with trauma that has passed into
everyday language.
Dr Summerfield says claiming to
have been traumatised, "has become the means by which people seek victim
status in pursuit of recognition and compensation".
The original idea of
psychological trauma has been extended to cover extremely unpleasant but
otherwise "ordinary" events like being mugged or suffering a serious
traffic accident, he says.
There have even been cases of
people claiming to have been traumatised by the shock of receiving (inaccurate)
bad news from a doctor.
This new band of victims are
supported by what Dr Summerfield calls "a veritable trauma industry"
consisting of an army of experts, lawyers, advocates, claimants and other
interested parties.
The workplace, he says, is more
and more seen as a "traumaogenic environment".
The popularity of post-traumatic
stress disorder and other types of "medicalised" unhappiness, he
says, comes from a feeling that nothing can be done about the social or
economic causes of unhappiness - such as poverty or social injustice.
Post-Traumatic Stress Disorder,
he concludes, "is the diagnosis for an age of disenchantment".
Courtesy of BBC website
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