There's+an+Elephant+in+the+room!+Mental+illness+=+Money

Name: Louis Paitson Sn: 6405339 Tutor: Judith Meiklejohn


 * Cultural Artefact**

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The Marketing of Madness is a full length documentary critically exploring the pharmaceutical industry and their ties and influence with the scientific, psychiatric and medical worlds in relation to mental health treatment with psychotropic drugs. The documentary portrays the mental health industry as corrupt, unethical, profiteering, ineffective and dangerous. The documentary, released in 2009, was produced and directed by James Colquhoun, and commissioned by a non-profit organisation called the Citizens Commission on Human Rights (CCHR). CCHR was founded in 1969 to investigate and expose psychiatric violations of human rights.


 * Public Health Issue**

This artefact represents where we are with mental health treatment within the western world. It focuses on what is wrong with the standard of mental health care that is in the United States of America (USA), that we closely mimic here in Australia. By exploring the scientific literature we can find the truth in what is portrayed in the documentary; that their are unethical ties between the pharmaceutical industry and psychiatry, that many psychotropic drugs are ineffective and have dangerous side effects, and that the methods of diagnosis are questionable. This documentary has further implications for what is then effective and plausible treatment, which can be addressed by looking at the cause of an individuals mental problems and addressing it, not the symptoms.


 * Literature Review**

Mental health is undoubtedly a major public health issue here in Australia. In 2003 mental illness accounted for 13% of the total burden of disease in Australia (Australian Bureau of Statistics, 2006). In the 2004-05 Australian Bureau of Statistics (ABS) National Health Survey (NHS) we can see a statistically significant large increase in the prevalence of mental and behavioural problems from previous surveys. In 1995 5.9% the survey population reported currently having a long-term mental or behavioural problem, which jumped to 9.6% in 2001, and then 11% in the 2004-05 survey. In a different survey, the National Survey of Mental Health and Wellbeing of Adults conducted in 1997, it was found through diagnostic criteria that 18% of the population had a mental disorder at some time in the 12 months leading up to the survey (ABS, 2006). So it seems clear that Mental illness is a major issue that is growing here in Australia. The most prevalent categories of disorders reported in the 2004-05 NHS survey were mood problems, such as depression, which came in at 50% of respondents, and anxiety related disorders at 46% (ABS, 2006). Both of these disorders are treated with psychotropic medications.

There is major concern with the credibility of trials conducted in order to gain approval of medications. A meta-analysis on efficacy trials in 2001-02 for new drugs approved by the Food and Drug Administration (FDA) gives insight into this concern. Studies with favourable outcomes were about five times more likely to be published, 47% of pre-specified primary measures in the trials were not included in the published results, and only 17 measures were shown in published studies of which 15 were for positive effects of the drug, biassing the studies to conclude to a greater efficacy then was measured (Pigott, Leventhal, Alter & Boren, 2010). Add to this the large drop-out rate of participants due to side-effects and increased suicidal tendencies that aren’t included in the results, the increased placebo effect that would occur from actually experiencing side effects reducing the use of blinding (Piggot et al, 2010), the practice of dropping participants that improve while receiving a placebo, and having a run-in phase where those with bad reactions to a drug are dropped and not included in the final analysis (Leo, 2006), the credibility of these published Randomised Controlled Trials (RCT) are over inflated and misleading.

This begs to question are psychotropic medications really effective treatments or are they industry driven products that are created for profits and not the mental well being of individuals. As stated above many trials go unpublished. When looking at antidepressants, 37 out of 38 FDA registered studies showing positive outcomes were published, and only 3 out of 36 negative papers were published. When data from all the clinical trials of four new generation antidepressants were analysed, no significant difference between drugs and placebo were found (Fava, 2008). Another meta-analysis of 47 trials of six FDA approved antidepressants found 57% of trials found no statistical significance between drug and placebo (Piggot et al, 2006). Another article, by Healy (2009), cites 80% of the positive response being reproduced by placebo. With this kind of evidence it starts to become clear that these drugs are certainly much less effective then we are led to believe.

The worst case scenario you might say for someone suffering depression, anxiety disorders and other mental illness is suicide. Therefore common sense would dictate the standard of practice for treatment would reduce suicides. However this is not the case, a review of adult Randomised Controlled Trials (RCT) by the FDA showed a 309% increased risk of death from suicide when on antidepressants of ages 18-64 (Healy, 2009). Looking at the use of these antidepressants in children is even more controversial. In the United Kingdom many antidepressants are now banned for use in those under 18, and in the USA they contain a warning (Leo, 2006). A common antidepressant used today, Zoloft, had in one trial 9% of the children on the drug engage in suicidal acts, yet these weren’t published in the final paper as the author’s had decided to only publish side effects of about 10% of the participants (Leo, 2006). A study on another antidepressant, Paxil, published a paper that concluded that the drug is effective for major depression in adolescence, yet the data showed no significant difference between Paxil and a placebo, and significant side effects in the Children taking Paxil, with suicidal thoughts being labelled as emotional lability (Leo, 2006). While promoting the use of this drug in children and having supposed peer-reviewed published literature supporting the efficacy of it’s drug, an internal document was leaked in 1998 from GlaxoSmithKline referring to the same study stating that the drug was ineffective and it would be commercially unacceptable to include that efficacy had not been shown (Leo, 2006). The increased suicidal acts and thoughts while on medication has been shown in clinical trial data since 1988, yet this has been downplayed, ignored and often unpublished (Healy, 2009). With this kind of evidence it appears their is a corruption of the medical literature and clinical practice by industry motives, to the detriment of the mental health and wellbeing of those most vulnerable.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual used to diagnose and categorise mental disorders. It is created by the American Medical Association (AMA) from the votes of 170 expert panel members across 18 panels (Cosgrove, Krimsky, Vijayaraghavan, & Schneider, 2006). By multiple screening measures including tracking publications, the US Patent and Trademark office database, news-media database Lexis-Nexis and internet search engines, it was found that 56% of panel members had one or more financial ties with pharmaceutical companies, and 100% of members on mood disorder and psychotic disorder panels had such ties (Cosgrove et al, 2006). Although this study doesn’t show the extent of actual influence the pharmaceutical industry has over the creation of the DSM, it certainly shows a conflict of interest. When the DSM is directly used by Psychiatry to diagnose and prescribe medication it is clear the pharmaceutical industry rely on the DSM to sell their products.


 * Cultural and Social Analysis**

This issue stems from the current ideology of modern medicine, and reliance on pharmacology for treating symptoms, the pill for every ill paradigm that permeates society (Fava, 2008; Rubin, 2006). It is a view that has been happily propagated through marketing campaigns by industry giants that rake in unbelievable profits (Rubin, 2006). Coupled with the diagnostic creation of mental illness out of typically normal responses to stressful situations (Horwitz, 2007) and the systematic corruption of scientific literature (Leo, 2006), the pharmaceutical industry has blurred the line of mental health and illness to the point that almost anyone can be classified as mentally ill and need medication (Rubin, 2006), and be justified by science to the extreme benefits of pharmaceutical companies and their shareholders. It is a highly capitalistic world that we live in that allows this to happen. When money makes the world go round, those with the money choose how the world goes round.

Awareness of this issue is minimal. The public generally trust the medical establishment and the supposed science backing it up, and continue to be medicated by ineffective and dangerous drugs (Pigott et al, 2009; Healy, 2009; Fava, 2008).

Those devastatingly being affected by this issue are those most vulnerable in our society. Those with debilitating mental disorders who rely on the standard of treatment used today to treat their condition, often these people have no choice in treatment options. Another highly affected group are those whose up’s and downs due to their life circumstances and dealing with issues, such as loss of a loved one, divorce or other issues are being classified, stigmatised and treated for mental illnesses because the economic drive allows it to happen.

If this paradigm is not effective in treating mental disorders, we must look to what is. All disease has a cause and the only way to effectively treat a disease is to address the cause. With Mental Disorders it is clear psychological distress from ones life is a clear cause of many disorders (Fava, 2008). Therefore psychological treatments, such as cognitive behavioural therapies, are effective treatments (Fava, 2008). These treatments are commonly used today, but not a focus of care. A lesser known cause of mental illness is that of toxicity. Many toxic substances such as lead, mercury, aluminum, pesticides, plasticizers and endocrine modulating substances that are often more common in the modern world are neurotoxic and cause malfunctions in the brain, causing behaviours categorised as mental illness (Genuis, 2008). Treating these patients with psychotropic drugs does nothing to cure their problems. Whereas removing the source of toxicity and/or chelation therapy can completely remove their symptoms (Genuis, 2008). Another therapy that shows promise is nutritional and herbal therapy. Some herbal remedies such as Kava and St John’s Wort are as effective as the reported effectiveness of commonly used antidepressants (Hoffman & Fox, 2006). Nutritional deficiencies are a known cause of mental illness, and show great promise as inexpensive and effective treatment (Melanson, 2007).

In order for these effective treatments to be implemented and a paradigm change in our society to occur major changes need to take place. The governing and regulatory bodies that are in place to protect society from the insidious and inscrupulous economic giants of the world need to take action. However, as the corruption is far reaching it seems improbable change will occur without the outspoken word and power of the masses, therefore the truth and power of this information needs to be known by society.


 * Artefact Analysis and Learning Reflections**

This artefact is powerful. Documentaries hold a power to educate people under the guise of entertainment. They represent a voice that generally will not be heard in main stream media, and can unfold a world of corruption and deceit. Access to this material through modern social media allows this information to be free to anyone, empowering society to make more fully informed decisions and pressure governments to make change.

I find it important to see that the supposed gold standard of science, the double-blind RCT, can easily be manipulated to create a published paper with results that could almost be considered fabricated. The science that dictates the practices of many well meaning doctors and even psychiatrists can falsely lead to the large scale pedaling of mainly ineffective drugs to a trusting and pliable public, with devastating consequences. This knowledge has had the effect of making myself aware to dig further in scientific literature truly analysing the methodology of a study. It has certainly made myself less trusting of psychiatry and the medical community in general.

My learning and thought process has greatly been affected in that I no longer blindly trust the establishment when industry is involved. I am studying Nutrition and Dietetics, and I see powerful industrial complexes having a large impact on the knowledge that is perpetrated as good nutrition. For example, scientific data shows the consumption of cow’s milk in a country is very strongly correlated to the occurence of osteoporosis (Campbell, 2005), which is the opposite of what is taught, and further exploration of this issue has opened my eyes to the similar corruption entailed in this piece. When the Dieticians Association of Australia (DAA) is largely supported by the dairy, grain and meat industry, profit driven organisations, optimum nutritional information may be lacking. From my experience it certainly is, and again documentaries become a modality to share this information at a grass roots level. We need to open our eyes to the proverbial Elephant staring us in the face and do something about it.


 * Reference List**

Australian Bureau of Statistics. (2006). Mental Health in Australia, 2004-05. Retrieved from [|http:// www.abs.gov.au/ausstats/abs@.nsf/mf/4824.0.55.001].

Campbell, T. C. (2005). The China Study: Startling Implications for Diet, Weight Loss and Long-term Health. Dallas, TX: Benbella Books Inc.

Cosgrove, L., Krimsky, S., Vijayaraghavan, M., & Schneider, L. (2006). Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry. //Psychotherapy and Psychosomatics// 75(3), 154-160.

Fava, G. A. (2009). The Decline of Psychiatry and the Increasing Role of Psychological medicine. //Psychotherapy and Psychosomatics// 78(4), 220-227.

Feher, J., Kovacs, I., & Gabrieli, C. B. (2011). Role of gastrointestinal inflammations in the development and treatment of depression. //Orv Hetil 152//(37), 1477-1485.

Healy, D. (2009). Are Selective Serotonin Reuptake Inhibitors a Risk Factor for Adolescent Suicide. //The Canadian Journal of Psychiatry 54//(2), 69-71.

Hoffman, R., & Fox, B. (2006). Alternative Cures That Really Work. New York, NY: Rodale Inc.

Horwitz, A. V. (2007). Transforming Normality into Pathology: The DSM and the Outcomes of Stressful Social Arrangements. //Journal of Health and Social Behaviour 48//(3), 211-222.

Leo, J. (2006). The SSRI Trials in Children: Disturbing Implications for Academic Medicine. //Ethical Human Psychology and Psychiatry 8//(1), 29-41.

Melanson, K. J. (2007). Nutrition Review: Relationships of Nutrition With Depression and Anxiety. //American Journal of Lifestyle Medicine 1//(3), 171-174.

Pigott, H. E., Leventhal, A. M., Alter, G. S., & Boren, J. J. (2010). Efficacy and Effectiveness of Antidepressants: Current Status of Research. //Psychotherapy and Psychosomatics 79//(5), 267-279.

Rubin, L. C. (2006). Psychotropia: Medicine, Media, and the Virtual Asylum. //The Journal of Popular Culture 39//(2), 260-271.

Shah, A. A., & Finucane, T. E. (2007). Yes, Industry influence is excessive. //International Psychogeriatrics 19//(1), 1004-1010.


 * Comments**

I really love the concept of affluenza. I agree this underlies much of what is wrong with our society, this generation of a money based value system. Where we are taught to strive for and value material possessions in order to reach a state of happiness. I think happiness and contentment in life can only be achieved through the valuing and appreciation of non-material wealth, such as relationships, family, health etc. This seems to highlight the difference you speak of between the developed and developing nations, where the divide in socioeconomic status is vast. However here where we are much more prone to influence (media, culture) towards striving for and valuing material things over social capital we find the ideal of happiness much harder to grasp. Thankyou for this thought provoking and intelligent piece. ||
 * < [|n6405339] Nov 6, 2011 3:36 pm

I found your analysis very informative. After reading this I am surprised both sides of the argument don't realise they are both right. The science clearly seems to show human contributions are warming the planet, and there seems merit that we are entering a natural warming cycle. Which don't you think is even more dire to life on this planet? I think while we are economically driven to exploit the resources we have on this planet, action wont come until the populace are directly affected and push for change. Unfortunately I think our governments around the world are far too influenced by money making corporations to make any measurable difference. Thank you for the enlightening analysis. ||
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