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The Manufacturing of Madness

The Manufacturing of Madness:
Profits Before Progress
Corporate profits put before patient progress can cause treatment failures.

Drug companies have been instrumental in promoting psychiatric diagnoses designed to market drugs. These corporate giants persuade consumers that a gamut of what may be common human feelings can be interpreted as serious psychopathology. They even invent diagnoses in a way that will best sell costly and profitable drugs. People suffering from emotional problems are often duped into adding to corporate profits and become distracted from the possibility of making progress in coping with their pain. A great deal of the retreat from using descriptive and sometimes unsettling language to describe one's psychological landscape has been vigorously encouraged by the pharmaceutical industry.

Shyness is labeled social anxiety disorder, a diagnosis unheard of by therapists before SmithKline Beecham began using the diagnosis to sell their anti-depressant Paxil. Carl Elliott, a bioethicist at the University of Minnesota, stated in The Washington Post: "The way to sell drugs is to sell psychiatric illness. If you are Paxil and you are the only manufacturer who has the drug for social anxiety disorder, it's in your interest to broaden the category as far as possible and make the borders as fuzzy as possible."

Grief at the loss of a loved one can be diagnosed as Major Depressive Disorder and treated with anti-depressants when actually a bereavement group would probably be most helpful in helping a person to mourn. ADHD is a neurological problem that is often best treated with medication, but distractibility and lack of focus are often symptomatic of family problems, learning differences, depression and worry. When a child or an adult is misdiagnosed as having ADHD, prescriptions for psycho stimulants, the treatment of choice for ADHD, can be disastrous and create a whole new set of serious symptoms.

The over-emphasis on medical and scientific jargon has been an American tradition in the mental health community since Freud was originally translated into English. Many years later, the German-born American Psychiatrist Bruno Bettelheim who delineated the inaccuracies of Freud's translators. He noted how humanistic words were changed into scientific ones in order to achieve medical legitimacy in the U.S. For example, rather than use the word "attachment," which says so much, Freud's translators used the term "cathexis" because they felt it would give psychiatry greater legitimacy.

A young woman who came to see me recently told me "I'm a Bipolar Disorder II and I also have obsessive compulsive disorder and self-mutilation. I'm on medication but still can't seem to stop self-mutilating. Can you suggest ways to help me stop this habit?" The young woman above needs to express herself in English. It doesn't help her to know she's a Bipolar Disorder II, but it would help her to verbalize how frightened, alone and out of control she feels. Her medication may or may not be helpful to her, but this girl needs a community of support, a professional who can help her sort things out, and parents who will listen to her anguish, pain, and fear. Mostly this young person needs to know that they are engaging in an activity that can easily be treated with behavioral therapy. It does not help her to know scientific jargon and diagnostic categories. It would help her to talk about how she feels and be part of a clinician client team creating a behavioral plan for eradicating the symptom of self-mutilation.

When a teenager tells me however, not that she has Bipolar Disorder II like the girl above, but that she is so lonely, sad, and deadened by pain that she needs to slice herself with a razor or burn herself with cigarettes, I feel profoundly sad for her. But, I feel hope for her as well; I know that this woman stands a good chance for recovery, because she is able to talk about what she is feeling in plain English. It seems, however, that we no longer speak English in America. We talk scientific jargon and labels: Bipolar Disorder II, Social Phobia, and Obsessive Compulsive Disorder. Distance from experience and feeling seems to be the symptom as well as the purported cure nowadays.

Let me make it clear that I am not anti-medication and my experience as a therapist confirms that psychiatric drugs can, and are, a lifesaver for many individuals. For others patients, however, medication designed to market psychiatric drugs inhibit the success of treatment because the best interest of patients is superseded by the greatest corporate profits.

Using scientific jargon is just a way to label things. For a patient, a label is an "easy" way to make sense out of confusing and conflicting emotions. The problem with labels is that people become comfortable with them. Oftentimes, rather then seek out the cause of their unhappiness by exploring uncomfortable emotional terrain; people will simply accept the label of a diagnostic category as an immutable statement of fact. They think: "I am Bipolar Disorder II. That's just the way it is. I guess I'll have to live with that."

Let's change our vocabulary back to English, and let the girl who's cutting herself with razors talk about feeling numb, self-hatred, alone, lonely, desperate and full of hatred and rage. Talk about feeling; forget about labels. Forget about detached terms such as Bipolar Disorder II and Social Phobia. I single these out because they are new diagnoses, coined in recent years, and we therapists have practiced successfully for decades without these diagnostic categories. They say NOTHING to a patient. That is why I advocate a return to English within the mental health community, for talking about the painful feelings, sharing them and expressing them, is what really helps people understand themselves and feel better.
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