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One Nation on Medication

Mental illness is a widespread issue in today’s society. In the United States, rates of people diagnosed with mental illness are climbing every day. The question is, is our society just becoming more and more mentally ill or is what constitutes a mental illness so broad that nearly everyone could be considered mentally ill? How does capitalism influence the diagnosis of mental illness?

                                                        One Nation On Medication

    Mental illness is a widespread issue in today’s society. In the United States, rates of people diagnosed with mental illness are climbing every day. The question is, is our society just becoming more and more mentally ill or is what constitutes a mental illness so broad that nearly everyone could be considered mentally ill? Many factors play into the diagnosis of mental illness: the pharmaceutical industry’s capitalistic goals, the broad definitions of mental illness, the over medicalization of everyday issues, medication efficacy or lack thereof, and social problems within our culture and immediate social circles. This paper will attempt to examine the roots of mental illness (especially social roots) and also discuss the current widely used treatments for mental illness. I will also examine why some treatments, shown to lack evidence of efficacy, are still used to treat mental illness.
    The US has the highest rate of mental illness in the world. According to Harvard Health, half of all American adults will be diagnosed with a mental disorder at some point in their life (Harvard Health Publications). One in five children have been diagnosed with a mental disorder, meaning that twenty percent of children in the US have a mental disorder. In India, where there are an estimated 3,000 psychiatrists, the government and WHO estimates that only about one percent of the population suffers from mental illness (TED). Other countries besides India, like Italy, also have very low levels of mental illness. Why in the US is fifty percent of the population mentally ill versus India where one percent of the population is mentally ill? This is not due to that fact that people in the US are inherently more mentally ill than in India. This is because in the US, the pharmaceutical industry has little regulation on marketing prescription drugs. The US is seen as a place to make profits off of stressed out people, anxious about their health. Examining pharmaceutical sales plans demonstrates how pharmaceutical companies attempt to gain more profit through higher diagnoses of illnesses in the US. Mental illness is the easiest disease to diagnose people with, since there is no definitive physical proof of any mental disease and everyone experiences mental distress at some point. Anyone can be mentally ill and anyone can take a drug for mental illness in the US.
    Depression is often caused by sadness over the death a loved one,  a break up, frustration over social relationships, socioeconomic conditions, and feeling trapped in a job or situation. Although depression is supposed to only be diagnosed when situational stressors are not present, it is often still diagnosed when there are social or environmental issues.  Social causes of depression are also often overlooked by medical practitioners and people are automatically assumed to have an imbalance of serotonin. (The serotonin theory of depression is currently being discredited in the scientific community, but I will address that later.)  
    Inability to concentrate is often diagnosed medically in our society. Though, inability to concentrate is just a symptom of youth. Young animals are much more energetic and unable to relax than their older animal counterparts. Humans are also animals and young humans have energy and learn from being active and interacting with their environment. When a young child has a difficult time sitting at a desk for six hours they are diagnosed as ADD. This stifling of curiosity and energy in the young could be hypothesized as a cause for childhood “mental illness”. Even schizophrenia, a more serious diagnosis, can have social roots. University of Manchester researcher, Paul Hammersley discovered a link between childhood abuse and schizophrenia (Nauert). People who are exposed to mental illness, particularly suicide, within their social circle are more likely to have a mental illness, especially commit suicide, later on themselves. According to a US News report, “Up to 13 percent of suicides could be copycat, as a result of suicide clustering” (Koebler). Mental illness can be socially contagious, thus demonstrating that mental illness is often not solely biological. Because biology is not always the root of mental illness, biological interventions can be ineffective or even make problems worse. Social or psychological interventions can often help more than biological interventions.
The idea of biological problems as the only cause of mental illness is absurd and does not hold up to logic. Huge portions of the population spanning all demographics do not have lung problems or heart problems (until they are very elderly). Why then, do huge portions of the population of all demographics, old and young, have alleged brain problems or mental illness? The prevalence of mental illness would suggest that half of the population has a brain problem. Evolution would not allow for half of a society to have a dysfunctional brain. Issues with important areas of the body are weeded out via natural selection. That is why majority of the population is healthy until they pass into old age. The reason for such a high prevalence of mental illness is not inherent problems with half of the population’s brains or brain chemistry, it is the over diagnosis of mental illness. It could also be argued that our brains are maladapted for the stressors of modern society. In either case our brains are not the sole problem, the problem is social and environmental. “In rural Uganda, villagers were taught to deliver psychotherapy for depression — and 90% of those who received it recovered,” versus the comparison group, “who went to primary health care centers” and “only 50% bounced back” (TED). Psychosocial interventions like therapy are clearly more beneficial than medication (medication alone only benefits about thirty percent and often comes with severe side effects). Why then in America are we often attempting to fix these social issues with a biological medicine?
    The pharmaceutical industry’s pursuit of profit at the expense of the general population’s health is one of these social issues that propels the biological treatment forward, when there is evidence against it. The main factor influencing doctors’ prescribing habits is the pharmaceutical industry, rather than third party, non-biased sources (Dobson).  This is an ethically shaky relationship between doctors and pharmaceutical representatives, because doctors are in the business of healing people and pharmaceutical representatives are in the business of making sales. The more doctors are influenced by pharmaceutical sales representatives, the less objective science is influencing doctors.  Many drugs are effective (although some are not) but the over prescribing of medications to the general population has spurred an epidemic of mental illness.
    The pharmaceutical industry is one of top three most lucrative industries in the US, alongside oil (Rhee). Much of the pharmaceutical industry’s motivation is to generate revenue and raise stock value, in order have enough money to hire new scientists and develop new drugs. Every time a pharmaceutical company markets and sells a new patented product they generate more profit. These companies are also usually searching for cures for diseases or ways to help lessen suffering, but emphasis on the bottom line is immense.  In order to generate high revenue, pharmaceutical companies need to heavily market and sell their drug within the time limit that the drug is patented for. After a drug’s patent expires, other companies can create a cheaper generic version of the drug. Once a drug has multiple generics, the original company that created the drug looses profit. Within the time frame of the patent, pharmaceutical companies attempt to generate as much revenue as possible. Tactics used to generate this revenue can often be unethical and can hurt patients.   
    Often times when a patent expires, pharmaceutical companies create a “new” version of the drug that is just an isolated component of the older original drug. An example of this is Prilosec and Nexium, used for heartburn. Prilosec is a racemic compound, meaning that it has two parts, or isomers, making up the molecule of the drug. One of the parts is active and the other is an inert component of the molecule. When Prilosec’s patent ran out,  AstraZenica created the product Nexium. Nexium has the same active ingredient as Prilosec except instead, only the pharmacologically active isomer of the drug is used. When people purchase Nexium they are spending far more than over the counter, generic Prilosec for the exact same medication with the same active ingredient. There are many other drug companies that that utilize this technique to generate revenue including the antidepressant Celexa which is Lexapro, Ritalin which is Focalin, Provigil which is Nuvigil, the list goes on. These examples demonstrate the pharmaceutical industry’s incessant pursuit of money, over ethics and affordable treatment for all.
    Each year pharmaceutical companies spend billions of dollars marketing medications. A 2006 article in the New York Times stated that in The Journal of the American Medical Association, a group of prominent researchers found that about ninety percent of the pharmaceutical industry’s “$21 billion dollar marketing budget is directed at physicians” (Pollack). This marketing is often in the form of kickbacks or rewards for doctors who agree to prescribe the medications or attend seminars on the benefits of the medication. In Illinois alone doctors have been paid a total of $68,737,662 by the pharmaceutical industry as kickbacks to prescribe drugs (Merrill). Forest Laboratories, the makers of the controversial drugs Lexapro and Celexa, “Offered cash payments, expensive meals and entertainment to induce doctors and others to prescribe the drugs,” according to a lawsuit filed by the US government against Forest Labs. The lawsuit, “Also accused Forest of promoting Celexa and Lexapro for pediatric use, even though a study showed that they were no more effective than a placebo for children” (Crain’s). “Forest Laboratories created “preceptorship” programs in which physicians were paid up to $1,000 each to allow a sales rep to spend time observing their practice” (Merrill). Lexapro and Celexa have been linked to aggressive, violent behavior and multiple suicides in adults and children (among other side effects like weight gain, erectile dysfunction, sleep problems, headache, rigid muscles, hypertension). Besides Forest Labs, multiple pharmaceutical companies are facing multi-million dollar lawsuits from the government for kickbacks and illegal marketing tactics (Ortho McNeil, Pfizer, and AstraZenica are just a few of the many).
    Prior to the incriminating evidence against Forest Labs and Lexapro came out, doctors were lead to believe that Lexapro was the best medication despite its expensive cost. The reason doctors believed this was because Forest Labs sent out representatives with sample packages of medications for doctors, brought food and coffee to doctors’ offices, chatting with the doctors about the drugs, and paid for doctors to go on vacation, and have expensive meals if they attended seminars on Lexapro sponsored by Forest Labs.
    Psychotropic medications are not benign, harmless substances. Medication “cocktails” from doctors have been responsible for the deaths of numerous people. One of the most well known cases was Rebecca Riley, a four year old girl that was diagnosed bipolar by a Tufts University psychiatrist named Dr. Kifuji (CBS). Rebecca was diagnosed with bipolar at the age of two after having temper tantrums and yelling at her older brother (CBS). Many experts question if children can be diagnosed bipolar at such a young age. Children often have temper tantrums and rapid mood changes, but these are normal parts of childhood. In the eighties, studies were conducted that determined that it was impossible to diagnose children with bipolar (CBS). Despite this, there have been exponential increases in the number of bipolar diagnoses in recent years. “Since the mid-1990s, the number of children diagnosed with bipolar disorder has increased a staggering 4,000 percent” (Spiegel). “Today, it’s estimated that at least 1 million children in the United States have been diagnosed with the disease” (Spiegel). Rebecca Riley’s ten year old brother and four year old sister also were diagnosed with bipolar and treated at Tufts (CBS). All three of the children were given multiple potent psychiatric drugs at high dosages. Rebecca Riley’s mother gave her an extra half of a sleeping pill one night and the next day four year old Rebecca did not wake up. The psychiatrist Kifuji (whose medical license was revoked but recently was reinstated) says she did what she thought was right and was influenced in her diagnoses and treatment of “childhood bipolar disorder” by the Harvard psychiatrist Dr Joseph Beiderman (CBS). Beiderman claims that childhood bipolar disorder is a real and prevalent disorder that must be treated. Beiderman though, has received over 1.6 million dollars from pharmaceutical companies like Johnson and Johnson over a period of eight years. He did not report this money to Harvard (CBS).
    Beiderman’s research was originally spurred by his observation of ADD children. He ran a clinic at Harvard for ADD and noticed that some of the ADD children were far more violent and aggressive than other ADD children or children without any diagnosed mental disorder. What Beiderman failed to acknowledge in his observations was the effect of potent stimulant medications like amphetamines given to children with ADD. Stimulants themselves and withdrawal from stimulants can cause aggressive behavior and anxiety in many people, that can seem as if it is ‘bipolar disorder’. Doctors and the pharmaceutical industry often fail to acknowledge the fact that certain drugs can trigger behavior problems and other disorders. This often leads to the prescribing of more drugs sand the diagnoses of more disorders.
    The consequences of over-medicalization are immense. Ivan Illich, author of Medical Nemesis, states that, “The medical establishment has become a threat to health” (CBS). The pharmaceutical industry labels more and more common problems as medical issues that require treatment. Therefore more and more people become patients, generating more and more revenue for the pharmaceutical industry. Doctors are not completely complicit in this occurrence, although they do have some responsibility. It is a doctor’s job to help people with problems, but treatment from doctors becomes a problem when they over diagnose and over medicalize common problems, searching for perfect health, appeasing the pharmaceutical industry, and pursuing kickbacks. Many disorders could be considered the product of over medicalization. Seasonal effective disorder, PMS, alcoholism, and even clinical shyness, now a medical diagnosis, are examples. Even depression is subject to over medicalization. I personally knew someone who was sad after their relative died. Instead of the general practitioner referring the individual to a therapist or support group, the GP put the person on Lexapro, an SSRI, heavily marketed to GPs.  “One study found that nearly 80 percent of antidepressant prescriptions are written by medical professionals other than psychiatrists” (Insel). The drug Lexapro changed the person’s personality and outlook on life negatively. It did not help, if anything it made life more difficult for the individual and their family due to negative side effects (aggression, despondence et cetera). Many disorders, which are real disorders, are over diagnosed and strong drugs are given to people who do not need them.
    SSRIs have been marketed to a wide range of people making depression extremely common in our society. The issue is that the drugs for depression are not very effective and they cause a host of side effects. SSRIs are only effective in about thirty percent of people according to some studies, which is also similar to the efficacy of placebos (around thirty percent) (Insel). The Journal of the American Medical Association, “found no evidence of an association between the serotonin gene and the risk of depression, no matter what people’s life experience was” (Alliance for Human Research Protection). Other studies have demonstrated that low serotonin is not evident in the brains of depressed people. The serotonin theory of depression arose out of the creation of Prozac. Prozac was the first drug to solely work on serotonin. Prozac was no more effective (some studies show that Prozac was less effective) at alleviating depression than the older generations of antidepressants, the tricyclics. Tricyclics work on numerous chemicals in the brain (dopamine, norepinephrine, choline, serotonin et cetera). Prozac has fewer side effects like hypotension, drowsiness, and blurred vision, that come with tricyclic treatment. This is because Prozac primarily targets serotonin. Because of the few side effects of Prozac compared to the tricyclic antidepressants, Prozac began being widely prescribed by practitioners. The popularity of Prozac catalyzed the creation of the serotonin theory of depression (NPR). There are no direct peer reviewed studies though, on a large statistically significant population demonstrating the correlation between low serotonin and depression (Rhee). In fact, antidepressants that do not effect serotonin such as Bupropion (which only effects dopamine and norepinephrine), are just as effective, if not more effective than SSRIs. Studies where serotonin was depleted in the brains of animals and people, did not demonstrate that serotonin depletion caused the animals or people to behave or feel any more depressed. A recent study from 2012 demonstrated that Prozac, or fluoxetine, increases aggressive behavior and alters normal development in adolescent brains. Observed behaviors include aggression, hostility, and agitation (Science Daily). These type of behaviors and feelings people experience while on antidepressants have been linked to murders and suicides. Behavior while on antidepressants can also harm family and other social dynamics. If someone becomes aggressive while on antidepressants and takes out their aggression on people within their social circle, this can harm other people too. There is a domino effect of suffering related to ineffective treatment of depression and other mental illnesses.
    Money is currently driving our pharmaceutical and medical industries. This breeds misinformation to providers and patients. Doctors often remain misinformed until they engage in non biased information seeking from third party sources. Physicians also need to be more cautious about prescribing psychotropic drugs and end their ties to pharmaceutical representatives. Not until we reform our policies, medicine, and research to be centered around ethics, leaving greed out of the equation, will the mental health of our society improve. Major reform is needed in the pharmaceutical and medical industries. Research needs to be done into the true root causes of “mental illness” and more effective, less harmful treatments (often utilizing social rather than biological interventions) need to be developed. Hopefully future generations can end the relationship between greed and healing.

References
Alliance for Human Research Protection. 2009. “Gene Theory for Depression is Now         Discredited.” May 20. .
CBS News. 2009. “What Killed Rebecca Riley?” May 19. .
Crain’s New York Business. 2009. “Feds Accuse Forest Labs of Kickbacks.” May 21.
    .
Dobson, Roger. 2003. “Pharmaceutical Industry is Main Influence in GP Prescribing.” British     Medical Journal. 326 (301). .
Harvard Health Publications. 2005. The Prevalence and Treatment of Mental Health Today.
    May 16. .
Insel, Thomas. 2011. “Antidepressants: A Complicated Picture.” National Institute of Mental         Health. May 19. .
Koebler, Jason. 2013. “Study: Suicidal Thoughts Are ‘Contagious’ in Teens,” US News, May 10.
    .
Merrill, Jeremy. 2013. “Dollars for Docs: The Top Earners.” ProPublica, May 20.
   
Nauert, Rick. 2006. “Child Abuse Can Cause Schizophrenia,” PsychCentral, May 19. .
Pollack, Andrew. 2006. “Stanford to Ban Gifts to Doctors, Even Pens,” New York Times.
    May 20. .
Rhee, James. 2009. “The Influence of the Pharmaceutical Industry on Healthcare Practitioners’     Prescribing Habits.” Internet Scientific Publications. 7 (1).
Science Daily. 2012. “Fluoxetine Increases Aggressive Behavior, Affects Brain Development         Among Adolescent Hamsters.” May 20. .
Spiegel, Alix. 2010. “Children Labeled ‘Bipolar’ May Get A New Diagnosis.” NPR, May 20.
    .
Torgovnick, Kate. 2012. “Some Stats on the Devastating Impact of Mental Illness Worldwide,     Followed by Some Reasons for Hope,” TED Blog, May 20. .


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