When we ‘medicalise emotions’, we shift the responsibility for mental well-being away from a naturally resilient brain, into the hands of Big Pharma, who reap multi-billion-dollar profits by making them medical conditions.
When we talk of Big Pharma marketing, we visualize trade sanctions and bullying local governments. The process is usually much more subtle. Let me explain this with the example of a rapidly growing illness category—Mental Health. No one in their right mind can deny the devastating impact of poor mental health. Yet, it is heart-rending how it can be medicalized for profit.
Mental Health Definitions
On one end, we have conditions like lack of focus, insomnia, and emotions of grief and sadness. While, on the other end, mental illness includes debilitating conditions like Bipolar, Depression, Schizophrenia, and Trauma. These conditions are defined in the Diagnostic and Statistical Manual (DSM), the “bible of mental health conditions”, which is updated every few years. However, this bible is now being questioned, in its land of origin itself. The Chairperson of the DSM-5 task force, Dr Allen Frances, cautions the world against medicalizing normal conditions like grief, loss, and loneliness into medical conditions. He opines that psychiatry is converting millions of people into “patients” with systematic hyperinflation in diagnosis. He adds: “When we medicalize emotions, we shift the responsibility for mental well-being away from a naturally resilient brain, into the hands of Big Pharma, who reap multi-billion-dollar profits by making them medical conditions.”
Is Big Pharma Medicalising Emotions?
Numbers often talk better. USA is Big Pharma’s wet dream.
The usual narrative is that eastern countries and poor countries do not give importance to mental health. Fair enough! India has a long way to go, in making mental wellness centre-stage. But these sales numbers convey an awareness of mental health from the point of view of success of America’s Big Pharma, not necessarily healing. As American culture takes over the world, so does American definitions of mental health. In the book— The Globalisation of American Psyche–Crazy Like Us, author Ethan Watters, discusses how Post-Traumatic Stress Disorder (PTSD) is increasingly diagnosed following wars and natural disasters.
Mega Marketing of Depression: Japanese case study
Americanized version of depression is on the rise across the world, changing definitions, muzzling the local cultural contexts, and homogenising illnesses. I take this case study of from the book by Ethan Watters. In the late 1990s, the American definition of depression was unknown in Japan. Japan had a high rate of suicide, but Japanese psychiatrists did not regard it as an untreated case of depression. They attributed suicide to an ancient tradition, from cultural context to avoid shame and dishonour. The Japanese did not regard sadness as a great burden. There was no expectation to feel happy all the time. The Buddhist nature of mind regarded suffering as a normal part of life. Drug companies made efforts to change the cultural narrative making depression a buzz word. Marketing depression in Japan rallied physicians, opinion leaders, patient advocacy groups, PR agencies, famous actors, to convince people and change consumer consciousness, that there was no stigma. Now, not everyone in the marketing process is evil, but the final motive of sales is not known to all.
Depression marketed in Japan as ‘Cold of the soul’
The communication strategy was–Like you catch a cold and buy a cough syrup; Depression is “cold of the soul” and you can get an anti-depressant. In five years of intense marketing, 177 books about depression were published, compared to 25 in previous 5 years. Depression was the most mentioned word on TV. Directto-consumer advertising laws were circumvented, with self-assessments and questionnaires in newspapers and magazines, which prompted people to see a doctor. Overtime, the marketing efforts paid off. In a separate report, between 1998-2008, there was a 140% increase in clinics treating depression; 190% increase in diagnosis and 400% increase in sales of psychiatric drugs. Curiously, as sales shot through the roof, the suicide rates remained unchanged. But it wasn’t in anyone’s interest to talk about this lack of correlation. It was much later that the Japanese government set up suicide prevention cells, to bring down suicides.
Replicating Success in Other Markets
This sales and marketing strategy has been replicated around the world. Pharma marketing is very often about manufacturing an epidemic, over an SOS medication, using many different agencies, changing narratives, homogenising definitions and muzzling local cultures.
Anu Lall is a lawyer and has worked in the pharmaceutical industry in India, the USA and Europe. She is the Founder of YogaSmith and the author of four books using Yoga as an adjunct therapy. This is the second of a three-part series.