Take A Pill: The Phamacologizing of America

Our society has mastered the rhetoric of “personal empowerment.” So why do we willingly let the medical-industrial complex pick our pockets to control our moods? Since the beginning of recorded history, humans have gobbled substances to alter their mental state. But you need only go back 50 years to find the first stirrings of a North American prescription-drug culture.

Our society has mastered the rhetoric of “personal empowerment.” So why do we willingly let the medical-industrial complex pick our pockets to control our moods? Since the beginning of recorded history, humans have gobbled substances to alter their mental state. But you need only go back 50 years to find the first stirrings of a North American prescription-drug culture.

In that postwar dawn, the old low-tech ways of coping with life’s hard knocks – kicking the dog, reaching for a bottle, talking things out with a friend or an analyst – were starting to fall out of favor. They had stiff new competition from pills.

Housewives discovered that popping a tranquilizer in the afternoon seemed to lighten the load. Dads (like Beaver’s) were never without their anti-ulcer tablets. This was nothing less than the marshalling of science in the service of physical and mental health, and it was good and proper.

Could anyone have foreseen the day when the ideology of “Better Living Through Chemistry” would be practically encoded into our DNA?

At the beginning of the 21st century, we are a society that speaks the rhetoric of personal fulfillment and empowerment, even as the medical-industrial complex picks our pocket to pay for a pharmeceutical assault on the mind.

The number of new prescription drug treatments has soared in the last decade. So has the list of diagnosable “mental illnesses.” Whether the second is driving the first (an alarming thought), or the first is driving the second (a somewhat more alarming thought), it’s hard to deny the widespread perception that vast numbers of us are about this close to losing it on any given bad day.

The statistics grow more and more dramatic as what we used to call “personality” traits – shyness, say – are upgraded, like tropical storms, to the status of “pathologies.” Drug companies are all for such reclassification, since it creates a new family of problems for which they have the solution. (A common prescription for shyness is paroxetine – brand name Paxil). And it boosts the number of what the industry refers to as “drug-successful visits” to doctors. The psychiatric profession has an obvious co-interest here as well, in that it gains financially, and cements its market share, the more people are defined as having some sort of mental illness requiring psychiatric treatment.

Who loses? Pretty much everybody else. Those patients who are saddled with a doctor’s label of “sick,” when they may simply be stressed or hyperactive or insomniac, get the message that in some significant way they’re broken, and only a pharmaceutical fix will help. In the end, attaching a biochemical “cause” to an illness (i.e. too much re-uptake of serotonin in your brain), throwing drugs at it and closing the file just isn’t very helpful, it ignores other serious factors that might be at play. In postmodern life, more environmental variables than ever are mucking with our heads. Perhaps much of our “craziness” is simply a natural response to unnatural stimuli.

What does mental health mean, anyway? Some believe the term is becoming synonymous with social conformity. If that’s true, people who have different “perspectives” are ideal candidates for medication. Over the last five years, the use of methylphenidate (Ritalin) for the treatment of Attention Deficit Disorder in children has risen 700 percent. In many instances, Ritalin works – which is to say, it nudges unruly kids back into the fat part of the bell curve, where conformity is the norm. Drugs are the perfect tool to enforce the homogenization of behavior. But is this any kind of recipe for the mental health of a culture? (The psychologist Abraham Maslow didn’t think so. He called the normal, predictable behavior found in that middle-of-the-bell-curve zone “the psychopathology of the average.” Maslow doesn’t play well in the world of multi-national pharmaceutical companies.)

A hellion of a little boy, diagnosed as suffering with Attention Deficit/Hyperactivity Disorder, might in fact be neurologically advanced. His parents watch him zip around like lightening, getting into grief. Does that mean he has “trouble focusing?” Or is he so busy multi-tasking on several psychic levels that he’s actually showing signs of a more evolved psychology? Mom and dad can’t keep up with the kid, so they take him in for treatment. The label of some disorder is attached, and medication prescribed. It’s never too late to start the pharmaceutical regimen. The Journal of the American Medical Association reports that the use of psychotropic drugs, such as anti-depressants, has tripled in the last five years among children aged two to four years.

The drug industry puts immense pressure on the field of psychiatry to adopt the “medical model” of treatment. Since drug treatments for psychological disorders are often covered by health insurers – while therapy and counseling aren’t – psychiatrist are pretty much forced to treat, usually with drugs, the problems they encounter as medical “diseases.” The growing transcendence of the organic and chemical view of illness has coincided with newer drug treatments, such as fluoxetine (Prozac), launched in 1987. The world’s top-selling drug, Prozac, and its dozen or so near copycats have prompted researchers to redouble their efforts to discover still more genetic and physiological correlates of mental illness.

In truth, the newer drugs do seem to work. At least for some people. At least for short-term symptomatic relief. The side effects of such drugs, however, can run the gamut from depression (the very thing the patient may have been trying to treat) to hypomania, insomnia, suicide and in some extreme cases, homicidal tendencies. Because of the downsides of psychotropic drugs, and the lack of long-term evidence of their effectiveness, many other treatments are likely to be atleast as satisfying without the inherent risks. But the marketing of alternatives can’t compete with the power of the drug industry in offering a “cure.”

In 1998, American psychiatrists received 58 million patient visits and wrote prescriptions for $5.6 billion worth of psychoactive drugs – a 21 percent increase over the previous year. Why did professionals prescribe anti-depressant drugs so frequently when evidence has shown that counseling and cognitive treatments can be just as effective (used alone or in addition to phamacotherapy) in treating mild to moderate depression? Well, there’s the medical-plan coverage issue already noted. But another answer lies in the reality of physician “drug education,” and the continued pressures on physicians and patients into accepting the paradigm that there is a “pill for every ill.”

To hook your doctor on the newest wave of anti-depressants, the top 10 marketers of these drugs employed 12,429 drug reps in 1997 (the most recent year for which comprehensive stats are available). Samples in hand, the reps fanned out across the US knocking on doctors’ doors. They made 2.6 million trips to visit psychiatrists, and this kind of face-to-face salesmanship contributed to the average psychiatrist writing more than 1,800 anti-depressant prescriptions.

Drug company-sponsored functions habitually wine-and-dine physicians to promote the image of their products. Scott-Levin, a pharmaceutical marketing research company, reports that in the 12-month period ending in April 1997, the drug industry in the US held 148,000 “meetings” and “events” with physicians and pharmacists – with a total of 1.6 million attendees – and spent $945 million dollars marketing drugs to physicians. Couch- and group-therapy salesmen haven’t a hope against that kind of funding.

Taking drugs to cure symptoms is like removing the battery from an annoying smoke alarm. We might decide it’s worth the risk if we knew that the pharmacologizing of illness actually produced long-term results. Many drugs, however, simply mask the source of the problem. Some of us may prefer it that way (don’t ask, don’t tell); but shouldn’t we at least have the option to decide for ourselves? As it stands, many patients are prescribed medications without ever being told it’s unlikely the drugs will ever really make things “better” in any lasting sense. They may even make things worse.

The term “iatrogenesis” comes to mind. It refers to any kind of ailment you contract as a result of your doctor’s treatment. The number of adverse drug reactions (ADRs) every year rank as the fifth leading cause of death in the US. That number does not include overdoses, mistakes or drug misuse. The figures are tabulated directly from the hospital records of people who were given drugs as recommended by their physicians.

Right, then. If “all pharmacology, all the time” is no model for the treatment of mental illness, what is? There may be some value in looking to the extreme opposite end of the treatment spectrum, where folks like new-age “wellness” guru Andrew Weil toil away in their fashion. Weil eschews the chemist’s view. Depression, he maintains, is the “necessary consequence of seeking stimulation.” His prescription: a healthy dose of Buddhist meditation. Now, peering inward may not do the greatest amount of good, but it could well do much less harm, at least for some people, than taking psychoactive drugs. The same holds for simple practical solutions – “putting things right, ” as President Clinton likes to say, by targeting the environmental conditions that helped shape your problems in the first place. The unemployed mother of two who has skidded into depression might benifit more from free, accessible daycare than a three-month supply of Prozac. (Though this seems unlikely to happen; Western governments have made their spending priorties quite clear.)

Drug therapy is only effective when it’s aimed at the systemic problems of individuals. But human beings are social creatures. We don’t get sick in isolation, and we can’t fully heal in isolation, either. Simply creating better surroundings for ourselves – “unplugging” to allow more time to develop robust social networks, enjoying good food, exercise, sleep and play – may be the most efficient path to higher mental function. At least these methods might buy some time and breathing room as we try to figure out what else may be going on in our lives.

Here’s a good place to start the re-education campaign: discard the idea that miracle pills will always improve your life. No pharmaco-Xanadu exists. You should only take a drug if the opposite (i.e., doing nothing) is worse – and anyone who tries to tell you different is likely trying to sell you something. “A drug without side-effect is a drug without effect, ” is a saying among pharmacologists. For every pill, there is an ill. No matter what you do or don’t do, the long-run outcome is consistent and predictable. As a pharmacist friend recently put it, “life is a sexually transmitted, universally fatal disease.”

– About the Author –

Basil Smallwood is a pseudonym for a Canadian health-care consultant

Author: Basil Smallwood

News Service: Adbusters

URL: http://www.adbusters.org