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Sunday 16 June 2013

PSYCHO-ECONOMIC IMPERIALISM (DT 2013) + Two Relevant Articles by Dr Joanna Moncrieff "Psychiatric Imperialism: The Medicalisation of Modern Living," AND "Psychiatric drug promotion and the politics of neoliberalism." SEE HER AND HELP RESIST THIS MODERN DAY COLONISATION OF CHILDHOOD AT CONFERENCE IN MANCHESTER ON JUNE 28th.

 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)


Psychiatric Imperialism: 
The Medicalisation of Modern Living


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.


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

  1. Department of Mental Health Sciences, University College London, Wolfson Building, 48 Riding House Street, London W1N 8AA, UK.
  1. E-mail: j.moncrieff@ucl.ac.uk

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.

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.

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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