Medicalisation+of+Mental+Health+-+Does+it+Change+Anything?

N5454336 Tutor: Abbey Wed 3-4pm

=**Cultural Artefact**= [] This artefact is taken from an online youth services website in the United States. The article in which this image is featured debates whether or not medicating teens for mental illness is beneficial. The article states the advantages of medication for mental health issues, but also outlines that there are other methods to maintain a healthy and stable mind, such as exercise. The need for a consistent regime to maintain mental health is also made clear in the article, as well as the need to seek professional medical advice in regards to mental health and the treatment options chosen. This image depicts the reliance our society seems to have on pharmacological interventions for illnesses. Where there is a ‘pill’ for any and every perceived ‘illness’. =Public health issue=

With 25% of the world’s population likely to suffer from a mental illness in their lifetime (World Health Organisation, 2011), and one in five persons diagnosed with a mental health issue in Australia each year (Australian Bureau of Statistics, 2007), mental health is a pertinent issue to be addressed. There are a number of treatments available for mental health issues including, medication, psychotherapy, cognitive behavioural therapy (CBT), electro-convulsive therapy and hypnotherapy (Clarke & Gawley, 2009, Lake, 2008, Payton & Thoits, 2011, Rosenthal et al., 2002). This wiki will focus on depression as a mental illness and the medication alternatives to treat this debilitating illness, as well as the impact of “medicalisation” of depression, and the effect direct-to-consumer advertising is having on those suffering from mental illnesses and on society at large. =Literature review= Depression, in particular, Major Depressive Disorder (MDD), is classified as the occurrence of two or more depressive episodes each lasting two or more weeks. These episodes are characterised by a persistent low mood, diminished interest or pleasure in previously pleasurable activities, changes in appetite and sleeping habits, psychomotor agitation, difficulty concentrating and suicidal thoughts (Dziegielewski, 2010). There are a number of treatment options available to both alleviate the symptoms associated with MDD and to treat the underlying cause. Psychotherapy, CBT and counselling options are effective options to treat both the symptoms and cause of MDD, whilst nutrition, exercise and stress reduction techniques (e.g. yoga, meditation) can also be effective treatments (Lake, 2008). Medications such as antidepressants have more recently become the ‘go-to’ treatment of choice. Whilst these medications can have side-effects such as weight gain, decreased libido and gastrointestinal distress (Lake, 2008), there has been a 147.5% increase in antidepressant prescription rates in the United States between 1990 and 1998 (Clarke & Gawley, 2009). This increase coincided with a 10.9% decrease in the utilisation of psychotherapy.

It will be shown that there a number of reasons for this dramatic increase in pharmacological treatment for MDD, including medicalisation of mental illness, increase in direct-to-consumer advertising and increased consumer knowledge of mental illness and associated medications.

The increased medicalisation of mental illness occurs when previously non-medical problems are treated as medical problems, for example, male sexual performance, shyness and grief (Payton & Thoits, 2011). This allows issues such as deviance and sadness to become part of a biomedical model and no longer simply a part of everyday life (Clarke & Gawley, 2009, Lake, 2008, Payton & Thoits, 2011). With the advances in medical science and neuroscience, genetic and biological contributors to mental illness have overtaken the social theories of mental illness (Bendelow, 2004); consequently, these everyday issues become less of a social manifestation and more a biological illness that can be treated via pharmacological intervention. The media has played a significant role in the medicalisation of many real and perceived illnesses as well as the creation and expansion of illnesses (Bendelow, 2004, Clarke & Gawley, 2009, Lake, 2008, Payton & Thoits, 2011).

Clarke and Gawley (2009) believe that the media doesn’t view a depressed mood to be ‘normal’ during difficult life experiences, such as grief. These media campaigns have served to inflate the number and type of symptoms that are considered to be part of the experience of MDD. In the US, the pharmaceutical industry is the fastest growing area of the health care arena, and spending on advertising by these companies has increased more than 50% since 1996 (Rosenthal et al., 2002). And although much of this media is accurate and does not necessarily have a negative bias towards mental illness, it does push the notion of MDD being a physical problem and should be treated pharmacologically (Clarke & Gawley, 2009). The increase in advertising for such medication is argued to have a number of advantages including, an increased awareness of mental health in general, better informed consumers, increased likelihood of individuals seeking medical treatment, increased adherence to treatment plans, possible improvement in the doctor-patient relationship, increased competition among pharmaceutical companies resulting in a decrease in cost to the consumer and reduced stigma (as the person is no longer seen as “bad” but as having a physical illness) (Payton & Thoits, 2011, Rosenthal et al., 2002, Clarke & Gawley, 2009). However, there are numerous negative consequences resulting from this increase in direct-to-consumer advertising movement. While the consumer may be more informed, this could negatively affect their relationship with the medical provider, and result in a less effective, more expensive pharmacological option or the prescription of medication when it may not be the best or only option (Payton & Thoits, 2011, Rosenthal et al., 2002, Clarke & Gawley, 2009). There is also the unnerving perception that those with symptoms consistent with MDD are capable and have appropriate judgement of the best treatment option available to them (Clarke & Gawley, 2009). Those with mental health issues should have their treatment plans formulated by medical professionals, not the media.

Furthermore, researchers have found that while advertisements are generally gender neutral, there is an underlying subtext geared towards professional women who are seen as unbalanced and unable to cope in the modern world (Clarke & Gawley, 2009). These advertisements have served to increase the number of behaviours seen to necessitate medication. While men’s behaviours considered worthy of medication remain consistent with the diagnostic criteria required to diagnose MDD.

With this medicalisation of MDD, pharmacological interventions may be seen as the only option or as a ‘quick fix’, and consumers are less likely to engage in other non-medical interventions. Medicalisation is resulting in the over-prescription and overuse of unnecessary antidepressant medication.

=Cultural and social analysis=

The way society views mental illness, MDD in particular, has been shown to be evolving. From a highly stigmatised negative personal problem, depression is portrayed as an illness that, like diabetes or sexual function, can be treated with medication. Theoretically, this evolution of public perception should result in a reduction of stigma. Payton and Thoits (2011) tested the hypothesis that with the medicalisation of MDD and the extensive media advertising of medication to treat MDD that there would be a reduction in stigma. These researchers found through surveys of participants who were exposed to such media, no significant effects in stigma associated with MDD. Payton and Thoits (2011) concluded that instead of reducing stigma, these advertisements had the negative effects of medicalisation including the expansion of symptoms associated with MDD, believing everyday worries to be worthy of pharmacological intervention, and consequently seeking unnecessary treatment.

Examination of social theory results in conflicting views of the outcome of medicalisation of mental illnesses. Durkheim, in his work on suicide, notes that a disruption in social cohesion and social capital (the presence of community, engagement and civic identity) results in an increased risk of morbidity and mortality (Alpert, 1993, Kushner & Sterk, 2005). Durkheim believes that modern life is detrimental to this cohesion and capital and is the basis for the decline in birth rates, increased community alienation and gender role issues with a consequential increase in suicide rates and mental illness (Kushner & Sterk, 2005). Other researchers extrapolate Durkheim’s theory predicting a decrease in social capital to account for increased rates of heart disease, depression and diabetes; however, statistics demonstrate that Durkheim’s theory does not accurately represent modern life (Kushner & Sterk, 2005). Kushner and Sterk (2005) question Durkheim’s model, finding that it is those societies that are most integrated also have the highest levels of suicide. Wray and Colen (2011) believe that it is an over-integration of individuals in society that increases suicidal behaviour.

Employing Durkheim’s theory, in is possible to hypothesise that an increase in advertising and medicalisation of and about MDD would result in increased social cohesion and capital. An increase in social cohesion would lead to increased understanding and empathy within society, and should therefore result in a decrease in stigmatising attitudes and a decrease in suicide rates and depressive behaviour. It is from this theory that one can understand the marketing strategies put forward by pharmaceutical companies, and the need to medicalise MDD, targeting professional women who are struggling with both changing gender roles and the increased pace of society. Kushner and Sterk (2005) examined this theory, and although there seems to be a commonsensical link between an increase in medicalisation and social cohesion which should result in a decrease of mental illness and stigma towards mental illness, no such relationship was observed. This result lends support to the researchers opposing Durkheim’s views. An increase in the social cohesion of the community, through mass media and medicalisation of illnesses, may not be having the intended effect of reducing stigma, but instead simply directing individuals to seek treatment for ‘normal’ emotions. Although the emphasis of the illness is taken from the self and regarded to be of biological origin, there appears to be no less stigma surrounding mental illness.

=Analysis of the artefact and your own learning reflections=

This artefact represents the cultural shift towards pharmacological interventions for mental illnesses. It has been shown that today’s society is more likely to approach medical professionals for the treatment of symptoms that would previously not constitute a diagnosis for Major Depressive Disorder. This is greatly increasing the market for antidepressant drugs, while rendering other effective interventions such as exercise, therapy and stress reduction techniques as unwarranted and unnecessary. This pharmacological shift and medicalisation of mental illnesses however, is not reducing the stigma it is often associated with. It seems that we are becoming a society fixated on the easiest treatment option, and are happy to medicate for what would have previously been viewed as trivial, everyday emotions that are ‘normal’ and part of life. The media seems to need to create a world where everyone, everywhere should be completely happy, and any deviance from this should be rectified.

From this wiki production I have realised how influential the media is on this issue. And how unnecessary and invasive the media has seem to have become in what should be a personal matter that required a very individualised, unique treatment plan, devised by a medical professional and should consist of the most appropriate and effective treatment - a treatment plan that does not have to include medication. While I believe depression has a biological underpinning, I do not believe that such an illness should be medicalised to the extent it seems to have been (in the US at least).

References Australian Bureau of Statistics. (2007). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Retrieved from: []

Bendelow, J. (2004). Sociology and Concepts of Mental Illness. //Philosophy, Psychiatry & Psychology//, 11:2, 145-146 Clarke, J. & Gawley, A. (2009). The Triumph of Pharmaceuticals: The Portrayal of Depression from 1980 to 2005. //Administration and Policy in Mental Health//, 36, 01-101 Dziegielewski, S. (2010). DSM-IV-TR in Action [EBL version]. Retrieved from: [|http://reader.eblib.com.au.ezp01.library.qut.edu.au/(S(xskcywx3folgvdshj5oddbcr))/Reader.aspx?p=588968&o=96&u=oxMZo4KFDWNuFUrvAvvIcg%3d%3d&t=1320320936&h=F6321BFA0A7C372737297A419E805F2831D63C6F&s=5055418&ut=245&pg=491&r=img&c=-1&pat=n#] Kushner, H. & Sterk, C. (2005). The Limits of Social Capital: Durkheim, Suicide and Social Cohesion. //American Journal of Public Health//, 95:7, 1139-1143 Lake, J. (2008). Integrative Mental Health Care: From Theory to Practice, Part 2. //Alternative Therapies in Health and Medicine,// 14:1, 36-42 Payton, A. & Thoits, P. (2011). Medicalization, Direct-to-Consumer Advertising, and Mental Illness Stigma. //Society and Mental Health//, 1:1, 55-70 Rosenthal, M., Berndt, E., Donohue, J., Frank, R., Epstein, A. (2002). Promotion of Prescription Drugs to Consumers. //The New England Journal of Medicine//, 346:7, 498-506 World Health Organisation. (2011). Face the problem: invest in mental health. Online Brochure Retrieved from: []

= Reflections = Name: Jaqui Toumbas Title: Different Paths to Mental Health – Alternatives to medication for mentally ill patients Reflection: I really enjoyed your history of mental health medication, and was surprised to learn that it is only such a recent treatment. I also liked how you acknowledged the rise of the metrosexual and the impact this might have on male expression of depression and suicide rates. Hopefully this will have a positive impact and help to change the stigma surrounding the issue. The artefact you chose was also very pertinent to the topic, I hadn’t actually examined the lyrics or meaning of this song before, and now that you have pointed it out... it’s quite depressing. This was a greatly informative wiki, and I learnt a fair bit about the history of medication and treatment. I was unsure, however, of what relation the graphs and tables you included had to your argument. Additionally, it was great to hear that your bias was lifted against medication used to treat mental illness. I was unaware that there was such a stigma towards the use of medication, and the effects it has. A really informative piece and was enjoyable to read, thanks. Name: Rebecca Whalley Title: Stigma and Mental Illness – The Double Whammy In regard to your choice of artefact, I really enjoy this ad myself, and am really impressed that it is on national TV. I found the information you provided on how many areas of someone’s life can be affected by stigma very interesting. I was also unaware of the distinction between public and self stigma. It was also thought provoking to realise that with an increase in empathy within the community, this may lead to a decrease in stigma associated attitudes. (My wiki focussed on the medicalisation of mental illnesses. Medicalisation was theorised to increase knowledge, understanding and empathy surrounding mental illness and the medications used, however, it was found to be of null effect) I’m glad that you pointed out the fact that those in the health profession should be the first to rid themselves of stigmatising attitudes, however, I believe, from personal experience that unfortunately this is not always the case. Finally, I really enjoyed the analysis of your artefact, and it was great to see your change in perceptions of the impact stigmatising language can have on those suffering mental illness.