How Pharma Giants Are Getting Rich By Calling Our Life Problems 'Medical Disorders'

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?