in Thinking about psychiatry

The ‘it’s not me’ culture and the rise of psychoactive prescriptions or is there an epidemic of psychological disorders?

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. Consider the following statistics

In the UK the use of antidepressants increased by 234% in the 10 years up to 2002 (1).

In the USA 11% of women and 5% of men now take antidepressants. (2)

What can be causing this explosion in the demand for prescription antidepressants? It cannot be possible that in ten years the number of people suffering from depression in the UK has more than doubled.

Here are some of the possibilities:

In recent years we have been encouraged to view more and more problems that were previously considered to be normal and manageable parts of the human condition as mental diseases that require treatment.

The boundaries of well known disorders have been broadened. Psychiatric diagnoses are very changeable and what counts as a disorder is highly dependent upon prevalent social norms and beliefs. We are now inclined to medically characterise the ‘problems of living’.

Lesser known disorders such as panic disorder and social phobia have been publicised. These disorders can have a substantial overlap with normal experience. When this is the case the condition is then expandable, which allows the drug companies may claim that they abhor the inappropriate over-prescribing of their drugs safe in the knowledge that this will almost certainly occur anyway.

Drug treatment has started to colonise areas where it was previously thought to be unhelpful such as substance misuse and personality disorder.

Depression as a diagnosis has been promoted by drug companies, especially after the advent of Selective Serotonin Reuptake Inhibitors (It has been suggested that pharmaceutical companies turned their attention to antidepressants after the collapse of the market for benzodiazepines following the discovery of their addictive potential (3)

It is more acceptable to admit to being depressed

Antidepressants have become household names and books about them have become best sellers.

There are social advantages by being depressed. A ‘depressed’ person can be seen as less responsible for their behaviour and can lay claim to the sympathies of professionals, the resources of the welfare state and the language of victimhood.

Although we are living longer, our modern lives are becoming increasingly uncertain. The comforts of the welfare state are less, our working hours increased, job security decreased and pension schemes uncertain. We are actively encouraged by the media to be in a semi-permanent state of mild dissatisfaction in order to fuel consumer spending and are constantly fed a diet of soundbites fortelling imminent doom.

Why is this important?

Medications cost a lot of money. This money might be better spent elsewhere and could go towards other non drug based therapies

A society which has been convinced that it is ill is less likely to look for other solutions to tackling misery for example that their social conditions are caused by wanting Government policy and will be unable to mount an effective challenge.

Psychiatric illness is poorly understood and the ‘biological hypothesis’ of this sort of disease is unproven.

We disempower people by informing people that their only form of relief of their mental distress is via medication.
The idea that problems that were previously considered a manageable part of human existence are now only to be addressed with the help of professionals is likely to reduce personal coping stratgies (4) and reduce our self confidence’

Medications have side effects, some of these can be very serious and there have been allegations that pharmaceutical companies have sought to play down the harmful effects of their products. Many psychoactive medications have a deleterious effect on sexual function, something about which patients are seldom asked.

Ben Goldacre has made available an interesting podcast entitled ‘More than molecules – how pill pushers and the media medicalise social problems’ – in which he argues that the media are locked in a ‘Miracle cure/sinister hidden scare’ model and that pharmaceutical companies seek to sell us preparations which they invite us to believe can cure complex social problems.

1 National Institute for Clinical Excellence (2004) The Treatment of Depression in Primary and Secondary Care. London: NICE
2 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.text
3 Healy, D. (1999) The three faces of antidepressants. Journal of Nervous and Mental Disease, 187, 174-180.
4 Moncrief, J. (2003) Is Psychiatry for Sale? Maudsley Discussion Paper

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