Beyond the biomedical model: Medicating sadness is not the solution

Our medicalized society turns certain states of mind into pathologies, reducing the complexity of the human being to a diagnosis with its corresponding pill.

In the 1970s the pharmaceutical industry experienced tremendous growth, and with this came a new, revised and expanded edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Sponsored by the psychiatrist Robert Spitzer, its purpose was, a priori, to provide psychiatry with greater medical reliability. Subject to successive revisions, this classification that lists and describes a huge variety of mental disorders has come to be used internationally.

The descriptions of the DSM diagnostic categories govern the world of medicine and psychiatry today.

This manual, endorsed by the scientific community, generally serves to unify practice for insurance providers, bureaucrats, and statistical studies. It is also possible that it helps some patients who seek the reassurance that a diagnosis can provide them together with their corresponding medication, which, sometimes, is even useful.

But we must not lose sight of the way in which such diseases have appeared and the primary function that their description fulfills.

A CHEMICAL CONCEPTION OF THE HUMAN BEING

Many of these disorders, often classified as behavioral, appear associated with a “recommended” drug treatment. In fact, the human mind, with its confused emotions, has hardly been drug-free throughout the 20th or 19th century.

In general, depression has become the most common disorder that psychiatric practice deals with, reaching 28% of all consultations. On its official website, the British Royal College of Physicians notes that there are currently around thirty different antidepressants available.

Depression, the most common mood disorder, is also the top earner for pharmaceutical companies. But without dialogue, self-knowledge, and social change, there can be no cure.

They began to be prescribed in the 1950s and are divided into four large groups: the old tricyclics; the MAOIs (monoamine oxidase); the preferred SSRIs (selective serotonin reuptake inhibitors), among which is the famous Prozac, now better known as fluoxetine; and SNRI (selective serotonin and norepinephrine reuptake inhibitor).

The Royal College admits, quite frankly, that the workings of these drugs are not fully understood, but they are believed to work by increasing the activity of certain neurotransmitters that pass signals from one brain cell to another. The chemicals most involved in depression are believed to be serotonin and norepinephrine.

THE HAPPINESS PILLS

Between 1988, the year it was introduced, and 2001, Prozac was prescribed to more than 35 million people around the world. In 1999, one million children in the United States were reported to be taking antidepressants, including mint-flavored Prozac.

The advertising budgets of the largest pharmaceutical companies remain huge, greater than the amount spent on research and development.

While it is true that when someone feels vulnerable or depressed they need help, we should remember that, as stated on the website of the Royal College of Psychiatrists:

• Many of the more common depressions go away on their own, without treatment, in about eight months.
• Between 24% and 35% of people improve after three months taking a placebo.
• Some of the patients listed in the 50% -65% improvement with drug treatment , during that same period of time, do so, too, due to the placebo effect.

Given that the World Health Organization recognizes that 33% of current illnesses are caused by medical treatments (i.e. iatrogenic or medically induced), less drug-focused medical care may be safer , especially after some of the hidden aspects of clinical trials carried out by pharmaceutical companies and the ineffectiveness of certain ‘safe drugs” have come to light.

OBSESSION FOR THE SPIRIT

One of the problems in our chemistry-dominated society is that the line between illegal recreational drugs and “cosmetic psychopharmacology,” as psychiatrist Peter D. Kramer aptly called it, is very fine. After all, antidepressants are “mood enhancers”, just like many of the illegal substances.

In both cases, the most important issue in life is the state of mind, the ups and downs and what produces them, above anything else. It has created a great deal of confusion about drugs, moods, illness, and behavior. The licit and the illicit, the honorable medical science and the traffickers, create a chemical conception of man that reduces him to two categories, mental disorder or criminality, with little distance between them.

The neurological perspective of life is not enough to encompass the complexity of the human being.

DEPRESSION AS RESISTANCE

Our chemistry-dominated society, with its periodic outbursts of faith in magical cures, sometimes manages to delude patients, doctors, and researchers that diseases can be easily eradicated or controlled, but reality often goes the other way.

This is especially evident in the histories of those who medical science – and those affected themselves – classify as depressed, bipolar or manic-depressive. In these cases, the pain is palpable, as is the confusion and nonsense. These histories reveal that life falls outside the current medical categories and what is labeled a cure.

There is the temptation to wonder if it would not be better to think that these chronic disorders (be they their genetic, constitutional, chemical or environmental causes) are part of the current human condition.

The famous French psychoanalyst Pierre Fédida pointed out that the only way to understand depression is by considering it inherent in a rapidly changing society that demands performance and initiative at all costs. In such a world, being depressed is a form of resistance, being inactive, and rejecting performance.

If now drugs are less toxic and can work, Fédida suggests that the real task is to get to know oneself better, through the dialogue that is established in therapy, to face the strong shocks of our time. Fortunately, there are still psychiatric professionals whose working methods are not limited to diagnostic manuals.

DISORDERS OF EACH TIME

It is helpful to remember that today”s disorders have been viewed differently in the past.

• Freud could have diagnosed a depressed person as hysterical.
• In America in the middle of the 20th century, he would have been schizophrenic.
• In the prepsychiatric world, with the horrors of asylum life, she would have had few options.

I do not condemn these times dominated by pharmacological psychiatry, since much of the assistance, medication and verbal therapy available effectively improve the lives of the people who suffer. But our journey through history warns us of something mental illness is also a simple name given by doctors of the mind.

The disease can provide the patient with meaning and definition for a time, but it can also inflict a stigma on them.

Many people go through some of the conditions that we now call mental illnesses or chronic mental disorders at some point in their lives. But there is, for most of these mental conditions, regardless of what we call them, a definitive cure or chemical cures that produce lasting happiness or emotional stability.