Condition branding (or manufacturing depression) (19 Nov 2007)

In the New York Review of Books, Frederick Crews (the Hawthorne scholar?) looks at three books that argue that depression has been fomented by the pharmaceutical industry, which stands to benefit directly from any increase in depression diagnoses. If you have ever seen the film Johnny Mnemonic -- if any of those 12 people are reading -- this will sound familiar:

Most of us naively regard mental disturbances, like physical ones, as timeless realities that our doctors address according to up-to-date research, employing medicines whose appropriateness and safety have been tested and approved by a benignly vigilant government. Here, however, we catch a glimpse of a different world in which convictions, perceived needs, and choices regarding health care are manufactured along with the products that will match them.
The corporate giants popularly known as Big Pharma spend annually, worldwide, some $25 billion on marketing, and they employ more Washington lobbyists than there are legislators. Their power, in relation to all of the forces that might oppose their will, is so disproportionately huge that they can dictate how they are to be (lightly) regulated, shape much of the medical research agenda, spin the findings in their favor, conceal incriminating data, co-opt their potential critics, and insidiously colonize both our doctors' minds and our own.

In Johnny Mnemonic, Keanu Reeves had to rescue the world from some pharmaceutically manufactured chronic disease that would make the world entirely dependent on an evil drug company's ministrations. (I think it also involved the perilous downloading of information into Keanu's overloaded brain.) The filmmakers probably didn't have SSRIs in mind then, but the analogy would have been apt: Citing one of the books, Crews notes the SSRIs "horrific withdrawal symptoms, such as dizziness, anxiety, nightmares, nausea, and constant agitation, that were frightening some users out of ever terminating their regimen—an especially bitter outcome in view of the manufacturers' promise of enhancing self-sufficiency and peace of mind. The key proclaimed advantage of the new serotonin drugs over the early tranquilizers, freedom from dependency, was simply false."

That loss of individual autonomy in the face of marketing campaigns and the slipperiness of diagnosing mental illness on the basis of a movable feast of symptoms is the part of premise of the books Crews looks at: Big Pharma uses advertising to transform what may once have been considered character traits into pathologies that one should treat with medication, promoting the sense that individual idiosyncrasy is a kind of disability that needs to be corrected, so we can all conform to the same master personality, the sort of synthetic pseudo-humans we see impersonated on television, people who are always happy, never hostile or self-sabotaging, never wracked by doubt, never anything but eager to cooperate and behave how society expects. Turning idiosyncrasies into mental health problems is known as "condition branding" -- the industry treats the name of a disease as a brand and promulgates it with the same marketing techniques that a company would use for toothpaste or laundry detergent, a process that has brought us social anxiety and restless legs syndrome and, these books argue, the depression epidemic.

Such a thesis is certain to offend lots of people who are debilitated by depression and may potentially see this line of argument as an attack on their right to feel better. For them, Crews has this rejoinder:

This isn't to say that people who experience infrequent minor depression without long-term dysfunction aren't sick enough to deserve treatment. Of course they are. But as all three of the books under consideration here attest, the pharmaceutical companies haven't so much answered a need as turbocharged it. And because self-reporting is the only means by which nonpsychotic mental ailments come to notice, a wave of induced panic may wildly inflate the epidemiological numbers, which will then drive the funding of public health campaigns to combat the chosen affliction.

The books are not simply denying the severity of a particular illness; instead they offer a subtler attack on individual autonomy, implying that people can be talked into feeling sick by advertising and other devious promotional campaigns. The premise of these books would seem to imply that people don't really know what to make of what they are feeling, and it's our inclination to turn to social norms for guidance. In our commercial, consumerist society, of course, those norms are bought and sold, and they hinge on solutions that permit for shopping and consuming objects with magic-seeming properties of transformation -- like, say, Prozac. Crews calls such drugs political sedatives, since any relief they seem to provide also serves to dissuade us from wondering whether commercial imperatives dictated their prescription.

But, as Crews explains, this is an old story, and it goes back to the imperatives that underlie the whole ediface of a consumer society, which hinges on an building an insecure populace that can be counted on to seek comfort in goods. Advertising is the art of creating dissatisfaction, and preying on personal vulnerabilities is an especially efficient way of accomplishing that end. The process is perhaps at its most extreme when the goods being advertised as medicines, and the dissatisfaction is elevated to the level of a disease that one ignores only at one's personal peril. The tendency of marketing to drift toward this maximalist approach is one reason sensible countries ban pharmaceutical advertising directed at consumers rather than theoretically disinterested medical professionals.