Over 16,529,142 people are on fubar.
What are you waiting for?
Source: Alternet
Some years ago, a friend told me that he had been diagnosed with a major depressive disorder and that his psychiatrist had given him a prescription for Forest Laboratories’ popular SSRI antidepressant Celexa (chemical name, citalopram hydrobromide; $1.5 billion in sales in 2003). Knowing him to be a vociferous critic of the pharmaceutical companies, I asked whether he agreed that the origins of his unhappiness were biological in nature. He replied that he unequivocally did not. “But,” he confided, “now I might be able to get my grades back up.”
This guy was, at the time, a full-time undergraduate student who managed rent, groceries and tuition only by working two part-time jobs. He awoke before dawn each morning in order to transcribe interviews for a local graduate student, then embarked upon an hour-long commute to campus, attended classes until late afternoon, and then finally headed over to a nearby café to wash dishes until nine o’clock in the evening. By the time he arrived home each night, he was too exhausted to work on the sundry assignments, essays and lab reports that populated his course syllabi. As the school year dragged on, he had become increasingly disheartened about his slipping grades and mounting fatigue and decided, finally, that something had to be done. So he’d seen the psychiatrist and was now on Celexa.
It is worth reflecting on this anecdote, and others like it, as research proceeds on the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a draft of which is slated for release in late 2009. When perceived through the aseptic lens of statistics, diagnostic rates, and other seemingly objective metrics, the urgency with which companies like Pfizer exhort us to monitor ourselves for sadness or restlessness and to “ask your doctor if Zoloft is right for you” assumes a superficially unproblematic aspect. According to the National Institute of Mental Health, over 17 million American adults are afflicted with clinical depression each year, costing the national economy $30 billion in absenteeism, inefficiency and medical expenses. Eighty per cent of those afflicted will never seek psychiatric treatment, despite the American Psychiatric Association’s regular reassurances that 80-90 per cent of chronic depression cases can be successfully treated, and 15 per cent will attempt suicide. Suicide is, indeed, the third leading cause of death among American youth aged 10 to 24.
Implicit to the drug companies’ messianic promises of health, happiness and economic productivity is a spurious parable of linear scientific progress: in spite of consistently inconclusive clinical trials, new psychotropic drugs are regularly marketed as improvements on old ones, ever more specific in their targeting of neurotransmitters, ever less productive of pernicious side effects. While revelations that put the lie to the industry’s feigned beneficence have belatedly crept into the mainstream press in recent years, the extent to which our lives and livelihoods have been colonized by the reductive logic of pharmaceutical intervention remains breathtaking. As Laurence Kirmayer of McGill University has suggested, the millennial rise of a “cosmetic” psychopharmaceutical industry, wherein drugs are “applied like make-up to make us look and feel good, while our existential predicaments go unanswered,” raises disturbing questions about the consequences of our willingness to use chemicals to treat forms of distress that would seem to signal not biological but social maladies.
Is it adolescent rebellion or “Oppositional Defiant Disorder”?
What is revealed about a society, in which drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress? How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?
In the summer of 2003, a small group of psychiatric survivors convened in Pasadena, California, to hold a hunger strike with the aim of forcing the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) to admit that they had no conclusive evidence to support their claim that mental illness is based in biological dysfunction. Though the APA was, at first, quite indignant, it did eventually issue a statement, three weeks into the strike, conceding that “brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive bio-markers of a given mental disorder or mental disorders as a group.”
This acknowledgement raises interesting questions. Although medical textbooks and even drug advertisements have, for years, admitted evidentiary uncertainties in psychiatric research (as a 2004 advertisement for a Pfizer antidepressant oddly proclaimed, “While the cause [of depression] is unknown, Zoloft can help”), the notion that mental disorders are ubiquitously and irrefutably founded in genetic, neurochemical and physiological anomalies is a mainstay of Western popular culture. The psychiatric fixation on brains and genes, vaunted in newspaper headlines on weekly basis, has quite deftly captured the public imagination, leading many people to view even mild forms of social maladjustment as pharmaceutically remediable. Today, we are everywhere urged to repackage ourselves into medicalized identity categories whenever we discover that we do not fit the productive, gregarious norm: the 8-year-old who cannot focus on her spelling exercises because of an energetic imagination has an attention-deficit/hyperactivity disorder, remediable with the aid of psychostimulants such as Ritalin or Adderall; the mother who cannot overcome her grief at losing her son in Iraq has clinical depression, readily dispatched with regular doses of Paxil, Prozac, or Lexapro.
Psychiatrist Joel Paris admits in his recent book Prescriptions for the Mind, that, “in reality, psychiatrists are treating conditions that they barely understand. Our diagnoses are, at best, rough and ready, and do not deserve the status of categories in other specialties. We have no laboratory tests that can reliably identify any mental disorder, and the measures we use are entirely based on clinical observations.” So, how is it that psychiatric diagnoses are now the driving force behind a multibillion-dollar international industry? “The force driving psychiatry today,” Paris readily grants, “is its wish to be accepted as a medical specialty.” Indeed, the history of this wish reveals much more about the inordinate preoccupations of psychiatrists than of their supposed beneficiaries.
Psychiatry did not always suffer from biology envy. The project of systematically categorizing and enumerating types of mental illness, in fact, began in the United States not as a medical venture but a criminological one. As philosopher of science Ian Hacking writes, in the wake of the Industrial Revolution, the increasing stratification of wealth and resources in Western societies prompted an exciting new pastime for the educated classes: the scientific documentation of social misery. Starting with “an avalanche of numbers that begins around 1820,” physicians developed a raft of new medical categories within which to group such behaviours as suicide, prostitution, drunkenness, vagrancy and petty crime. Informal attempts at condensing these data into diagnostic manuals were made in the ensuing decades: the 1840 national census documented occurrences of “idiocy/insanity,” while the 1880 census split these figures into seven discrete categories: mania, melancholia, monomania, paresis, dementia, dipsomania and epilepsy. Unsurprisingly, this precipitated a sharp increase in diagnoses of what became homogeneously known as “feeblemindedness,” and, by 1918, mental hospitals and asylums everywhere were bursting with inpatients. The earliest official medical nosologies of mental illnesses were then adopted in order to better manage the incarcerated populace.
