“You can’t set her free”: Pharmaceutical Advertisements and the Always Shifting Perceptions of Madness

Looking at the ways in which the psychiatric profession advertised for its drugs and treatments can tell us a lot about shifting perceptions of mental health. We’ll keep the explanations short here, but if you want a more thorough critique of psychiatry, read our article Schizo-Genesis // Mad Apocalypse: the Story of the Psycho here.

[Update 12/7/17] We came across some more advertisements recently that we really wanted to include, and so we decided that this post could be regularly updated to become a concentrated database of tropes and paradigms for pharmaceutical ads. The plan is to include the visuals that communicate something either essential or at least typical. If it gets too big, we’ll make separate pages for different sections.

We indicated at the end of Shizo-Genesis that pharmaceutical companies are big players in shaping the way previously non-medical problems are represented and branded as treatable diseases. [See this essay by Ethan Waters for a good summary of this line of critique] We argued that there is a

drive towards the hyper-individuation of “mental problems,” which apparently are unrelated to political events, but are merely subjective psychological, or even biological, defects in a person. This hyper-individualization of psychological speculation is driven or at least structurally supported by an immensely powerful pharmaceutical industry, which, as it attempts to capitalize on the untapped markets in the global south, is now the main exporter of Western notions of “mental illness” and its diagnostic criteria around the world.

Peter Conrad in The Medicalization of Society writes:

pharmaceutical companies are now marketing diseases, not just drugs. This change is in part a result of the 1997 changes in FDA regulations that allowed for “educational” broadcast advertising that focuses on the disease or disorder, rather than on a specific drug, and in part as a result of the pharmaceutical industry’s attempt to develop markets for its products […] While physicians are still significant […] we will see that physicians’ role in medicalization is decreasing as that of the pharmaceutical promoters is increasing.

Given that these perceptions continue to shift depending on the changes in the market, it makes sense to have an ongoing, updated database of images with some commentary to keep up. This is based in part off of efforts by the Bonkers Institute, which you can see here, but with the intent to provide ongoing commentary (as far as we can tell, they do not update anymore, nor include commentary). Some of the ads posted here were also found there, and they have a number of humorous articles on the pharmaceutical industry (here’s one making fun of the medicalization of addiction). We’ve also decided to include visuals from other sources that either are directly involved with selling or distributing pharmaceuticals, like guides for consumers and website visuals, so this post could potentially be said to be about “pharmaceutical visual culture” rather than strictly advertisements.

It should be said that none of this is intended to shame consumers of drugs, or question their life choices. It is, however, indisputable that the pharmaceutical industry has a heavy hand in shaping our perceptions of mental illness, and that their role in this process is influenced by the market for their drugs.

Lastly, if you have any suggestions or see an ad that you think should be here, email us at belliresearchinstitute [at] riseup [dot] net or sashavs [at] riseup [dot] net. Going forward, we will continue to add some vintage advertisements if they express something important or continuous with today’s representations, but will focus on more recent
ones.

Depression, Anxiety, and the Pathologization of “Personal Problems”

At the forefront of the medicalization of previously normal problems are the labels “depression” and “anxiety.” Unlike bipolar and schizophrenia, which remain forms of so-called “extreme mental illness,” these two diagnoses have become so widespread and normal that often one’s reaction to simple sadness or withdrawal is to ask whether or not the person is “depressed.” What is the difference between sadness or fear and depression or anxiety? Well, one difference is that the latter set are medical diagnoses that can be treated with drugs, or otherwise monetized by medical professionals. Another would be that the first set presents the possibility of seeing your ailment as an element of the environment you are living in, your material circumstances, your marginalization, or mistreatment at the hands of others (something is saddening/scaring me), while the latter two are largely presented as “chemical imbalances” (my body/brain is causing my depression/anxiety because I am imbalanced).

A satirical article from the Bonker’s Institute excitedly informs the audience about “asymptomatic depression” and the “huge untapped market” that lies within. They present a laundry list of totally everyday circumstantial problems like “having too much or not enough of something,” and “marriage to the wrong person,” and also serious geopolitical problems like “global economic collapse, thermonuclear war, mass starvation, genocide, etc.” as causes. For “symptoms,” they list again some very everyday activities and behaviors: “slumped shoulders; downcast eyes; inability to concentrate” as well as again political ones “tendency to worry about nuclear proliferation, vanishing coral reefs, mounting budget deficits and the legacy we’re leaving our children” This differs very little from the actual criteria for Major Depressive Disorder. In the DSM-V, the first qualifying symptom for the criteria of Major Depressive Disorder is having a “depressed mood most of the day as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).” How exactly is a “subjective report” or “observation” an element of a supposedly objective medical diagnosis? This isn’t the place for an in-depth critique of the language around depression or anxiety, but to examine some of the visual language used by pharmaceutical companies to sell us on it.

Depression hurts.JPG
Ad for Prozac showing what looks kind of like a child’s drawing of a rain cloud on one side with the words “depression hurts” and a sun on the other with the words “Prozac can help.” This ad is not exactly subtle, and the language is almost humorously insistent. The first two sentences of the text read “Depression isn’t just feeling down. It’s a real illness” as if they expect the reader to doubt them right away. The sincerity of this statement truly ought to be questioned when it’s qualified immediately by the presence of a medication claiming to treat it.
Shy or anxiety?.jpg
Ad for Zoloft. Ads for Social Anxiety and for Major Depressive tend to be very simple in nature. One possible reason is because, if they were too specific, then the viewer would not recognize their problems as a disease. This one shows an unremarkable woman, lighted from below, with her head down and her face partially covered by a hat. The light and the curvature of her nose give the impression that she may be sneering. Her dark lips and frown further indicate that this is a “dark” or “brooding” person. The words “is she just shy” are extremely vague for what is supposed to be a “disorder” or at least an “imbalance.”

Women, Hysteria, and Housework

This first group of ads shows the progression of certain “women’s issues,” which range from the classic “hysteria” to anxiety and depression disorders, to psychotic disorders. These disorders and illnesses tend to be portrayed as the causes of the woman’s failure to perform their household duties with a good attitude or else when they show “devious” sexual proclivities. A study by Donna Stewart, M.D., chair of women’s health at University Health Network and the University of Toronto in Canada called “Who Is Portrayed in Psychotropic Drug Advertisements?”  found that, in ads from three different psychiatric magazines in the years 1981, 1991, and 2001, women were portrayed in family roles 90% of the time, and in sleeping, leisure or passive roles 77% of the time.

electrobelt
1890 ad for an “Electropathic Belt” for Hysteria and “Weak Nerves.” “I can perform all my duties without pain” reads this “female testimony.” There’s not too much in the way of images here. A drawing of a woman stares blandly ahead towards the viewer, both wearing a belt over her dress and holding one in front of here, as if to offer it. This ad, unlike most of those to follow, actually promises a complete cure.
femfree
1967 ad for Serax. Nothing you can do about patriarchal power, but you can stuff your wife full of drugs! This ad, by placing the woman with her domestic appliances behind a veritable prison of brooms and mops, acknowledges that the duties entrusted to the normal housewife are oppressive and extreme and akin to being locked up, but then tells us that “Serax cannot change her environment, of course,” offering instead to “strengthen her ability to cope.” In other words, it allows her to continue living in the prison.
deviant
A 1973 ad for Anquil, a neuroleptic advertised as a cure for deviant sexuality: “exhibitionism, compulsive masturbation, incest, erotomania” and “anti-social sexual behavior.” We see an oversized face imposed over the dark bodies of sexualized women who even seem to be melting into one another staring darkly at us from about where the women’s breasts would likely be. This ad is puzzling, because it both exploits and warns of over-sexualization. It wants your attention, and seeks to gain it by showing idealized shadows of sexualized feminine figures in which a grotesque floating face seems to reprimand you. Is it trying to tell us that such a gaze is “anti-social” and that we perverts are like him? Or is he the face of “society” gazing at us gazing at these shadow ladies?
fempressure
Meprospan advertisement, 1967. Another example of advertising psychiatric drugs explicitly as a coping mechanism (a “tranquilizer”) for the pressures of household work. What exactly this child did to stress the mother out is unknown, but we can guess from his nudity and from her exhausted expression that something has just happened to off-set her mood/day. The drug offers “tranquility” but not salvation, once again. No solution, which could be sought in the reorganization of the family unit or of another social unit, just treatment.
2002-anti
These representations have remained largely the same. This is a 2002 ad for Paxil, which shows how this housewife became reintegrated into her family by taking anti-depressants. The top image shows the distant mother surrounded by her emotional and cognitive failings, while the bottom, post-paxil, image displays her smiling with her son in her arms.
2009-anti
And this scary one for Pristiq from 2009 seems to suggest that a woman is like a wind-up toy that, when beginning to fail, can use anti-depressants to help get through the day. This ad, by portraying the housewife as a wind-up, also seems to suggest the pessimistic idea that household duties are mechanical and wooden. It presents this first as a challenge by saying that “depression can make you feel” that way, but does nothing to alter the image, instead merely offering the anti-depressant on the bottom of the left side of the image with more information on the right. Will this drug eliminate the wind-up or merely make it run longer? By offering no counter-image, we must assume Pristiq can only offer the latter.

Children and their “Bad Conduct”

The second group shows some ads directed at parents of unruly children, or even just “weird” children. These problems were in the past generally viewed as anxiety related or else as “mental defections” while today they tend to be seen as “conduct disorders” like ADHD and Oppositional Defiant Disorders, which are much more commonly diagnosed than any previous disorders in children. Provisionally, it looks like such conduct disorders are the avant-garde of the social control mechanism of psychiatry, in so far as they both mix social/political factors with biogenetic assumptions and remain broad enough to be widely diagnosed. The diagnostic criteria for ADHD, for example, includes multiple references to difficulty with school work, or the school setting. This may seem obvious, but “school” is neither a biological fact nor a constant feature of human societies, yet it is mentioned here as if one’s behavior in it could be a symptom of a biological pathology. Psychiatrists often complain that their “science” is the only one with an “anti” wing. Not that the other sciences don’t merit criticism, but psychiatry is special in so far as it indiscriminately mixes the rhetoric of social deviance with the rhetoric of the genetic and biological.
Adolescent/child psychiatry is the new frontier. Prescriptions of antipsychotics are on a drastic rise. The Scientific American reports that
Between 2002 and 2009 pediatric prescriptions for atypical antipsychotics increased by 65 percent, from 2.9 million to about 4.8 million. A staggering 90 percent of those prescriptions are off-label, according to a 2012 study published in JAMA Psychiatry, with ADHD and disruptive behavior disorders accounting for about 38 percent of all antipsychotic use in children and teens.
In 1997, the FDA (in the Food and Drug Administration Modernization Act) loosened restriction on the information that pharmaceutical companies can distribute and allowed for “educational broadcast” advertising that advertises or educates about a disease or condition, rather than a specific drug, facilitating the widespread prescription of drugs for “off-label” use. This facilitates a mutual process of expansion whereby the availability of new drugs requires new markets, and new broad diagnostic tools allow for the pathologization of what was previously considered deviant behavior.
kidefect
Ad for Compazine, an antipsychotic and anti-emetic, not sure of the year, which promises “Prompt improvement in ward and cottage behavior, table training and toilet training”
different child
1959 ad for Equanil, a discontinued anti-anxiety drug, “for the child who is different.” This is a case of surprisingly direct marketing for managing difference with medication, so that the child may “enjoy a normal life.” The child is shown partially submerged in shadow, creeping around a corner alone with a dark passageway behind him. The descriptions provided for his “different” behavior, like the visuals presented here, are extraordinarily vague, and hinge, in the end, on the perception of the adults he spends time with. Who gets to decide whether nervousness is “undue?” Who can tell whether a tantrum is “exaggerated?” These aren’t quantitative terms, but discretionary ones. This highlights that pediatric psychiatry is the avant-guard of the policing mechanisms inherent to psychiatry. The police, in this case, are deputized adult-psychiatrists. This drug, like antipsychotics today, began as an adult-only drug and moved downwards through marketing for its off-label pediatric usage.
atomoxeteen
2007 pamphlet explaining ADHD medication Atomoxetine in over-simplistic and sugary language to kids, normalizing the medication of children. “It works in the brain to help you concentrate and listen better” does not actually tell you how the medication works or what it does chemically. While it does mention short-term effects, it does not mention either alternatives nor long-term effects.
ad_monster
Ad for Intuniv, an ADHD drug. This one is pretty straight forward: badness is illness, which is combined in the figure of the “monster,” and our drug can “treat” it, revealing the smiling, white child (the Western ideal of innocence) underneath. The crossed eyes are also the prevalent representation of learning disorders and cognitive disabilities. As such, this ad is either implying that their is a co-morbidity with ADHD and these disorders, or that ADHD, the monster, “causes” similar disabilities, which can be treated with the drug. They probably intended this to be just another “monstrous” trait, the implications of which are no less problematic.

Psychiatry and Anti-Blackness

This group shows the anti-blackness (and anti-indigeneity) inherent in the psychiatric profession, which makes illegitimate any alternative methods of care or diagnosis and presents any form of resistance to white supremacy as pathological. In the early 20th century, mostly white women who failed to perform their household duties were diagnosed with schizophrenia and other psychotic disorders, but, in the wake of the Black Power movement in the 1960s and 70s, the second edition DSM highlighted the “aggression” of the illness in its new description of symptoms. Jonathan Metzl: “In the 60s, National Institute of Mental Health studies found that ‘blacks have a 65% higher rate of schizophrenia than whites.'” As we wrote about in Schizo-Genesis, psychiatry was also a foundational discourse for colonial scientific racism, and the hierarchization of the races. Both trends are apparent in these ads: the degradation of the idea of the native, and the pathologization of resistance to colonial or white supremacist rule.
Haldol-ad.png
A 1974 ad for Haldol, an anti-psychotic advertised here as a curative for “aggressive and belligerent” behavior with an image of a black man shaking his fist. This image appeared in 1974, after a decade of the civil rights movement and a series of destructive race riots. Jonathan Metzl, in whose book we found this image, argues that these images proliferated explicitly to pathologize the rebellious behavior of black people and to ensure that more of them get locked up and/or seen as essentially sick. These images suggest that, instead of having legitimate concerns and arguments, the “angry black male” is simply a sick individual with a “brain disease” or a “chemical disorder.”
thoraztool
Antipsychotic Thorazine presented as “modern” tool opposed to “primitive” African tools (represented by a Ekpo mask from Nigeria and a “konde” from Zaire) while also highlighting its special use in controlling “psychotic agitation.” This anti-blackness and attack on traditional medicine is essential and not accidental to the project of psychiatry, which must discount and ridicule both other ways of seeing illness and methods of dealing with them to deepen its own hegemony and establish white doctors as the ultimate experts on health and illness. The “compare and contrast” visual language attempts to display a progression, as if one method belongs to the primitive past, and the drugs belong to the present. The advertisers of course do not mention the “effectiveness” of either, nor explain the practical uses and combinations of the former. This is unnecessary in their eyes. They do not want the viewer to actually consider them as tools, but to immediately recognize them as “primitive” and foolish. This both bolsters their authority by encouraging an “automatic” recognition of their abilities and knowledge while also denigrates the contemporary methods of those who oppose them or provide alternatives.
list the mask
A 1977 ad for Stelazine. “Remove the mask of schizophrenic withdrawal,” which is presented as an Tlingit Shaman’s tribal mask. This suggests not just an ineffective method of controlling or “treating” schizophrenia or any other psychotic condition, but goes further and implies that “primitive” culture is itself psychotic and equivalent to the “pathological” conditions. This is a double attack: the psychotics are like savages, while the savages are like psychotics. This means that the psychiatrists ought to have more power in treating the psychos, while the civilized ought to be able to “treat” the savages, who are also deluded.

Noncompliance is a Symptom of your Illness!

The last group shows the way in which the psychiatric profession trains the public to recognize the ill with representations of delusional psychos who would go to any length to convince others they were normal and resist treatment. The final conclusion of this is that 1. psychiatrists can identify when abnormal behavior is a symptom of pathology and not a legitimate form of protest or resistance to life circumstances, and 2. they know how to treat it.

deny
1981 ad for Proxilin informing the reader that the schizophrenic psycho may be hard to identify, and also that he may deny his own illness. But, don’t worry, because, with Proxilin, he need only be injected once a month, and hence, “will not have to be reminded every day of the illness they reject so strongly.” While it may seem, on the surface, that this ad is actually combating the stigma of a schizophrenia diagnosis and reminding the viewer that anyone may potentially be schizophrenic, this displacement from visual characteristics to visible behavioral patterns further strengthens the belief that one can identify the crazy person not based off how they look, but rather, how they are in a situation, or how they act.

black hood ad

9poison
Ad for Stelazine that recommends disguising medication to trick patients into taking medication they perceive as poison. Not for a moment do these ads entertain the idea that there may be elements of their medication that could rightly be considered poisonous (their effects on the long-term physiological health of the patient including extrapyramidal symptoms and rapid weight gain well recorded), nor is there any curiosity as to why the patient may perceive them as such. Instead, it is simply assumed to be a symptom of the central “disease” of schizophrenia. This again highlights the special character of psychiatry. It is the only medical profession where the resistance to it can be pathologized as a “symptom” of the illness they are treating. This is why we refer to it as a police science and not primarily a medical profession.

black hood ad.jpg

9recalcitrant
This ad for Haldol does much the same, noting that it is “tasteless” and difficult to detect. These ads visually construct the “patient” as an aggressor and enemy who needs to be controlled. By portraying this man in a state of aggressive non-compliance and confusion, this ad communicates to the viewer that the schizophrenic is a danger to himself and those around him. Rather than questioning the basis of that “danger” or its environment and representation, the ad suggests that Haldol can “treat” this danger.
9web
This 1982 ad for Proxilin promises to help “break the web of noncompliance” with an injection of the drug. What all these ads assume is that the oftentimes awful and painful side effects are preferable to the symptoms associated with schizophrenia and other psychotic disorders. They make this choice for the patient, who actively rejects this treatment and seeks to avoid it. It is a reality that some who have extreme or hallucinatory experiences prefer to take dangerous drugs over continuing to have such experiences, but there are others whose assertion of the ability to make that decision is interpreted as symptomatic. The visual of a “web” representing “non-compliance” is odd. Are they suggesting the patient is trapped in this web, or did they make the web themselves? Who is the spider and who is trapped? The web that reaches over the psychotic woman’s face suggests that she, the patient, is the one trapped in the web of non-compliance, and that the drugs placed over the whole ensemble represent perhaps a way out, but the visual metaphor here is not so clear and the possibility or a second reading is possible. The drugs themselves trap one in the “web of non-compliance” (being an asymmetrical power relation with the psychiatrist or prescriber) and it is only by lying and sneaking behind them both that one can escape.
iceberg
A 2006 ad informing the reader of the hidden danger of “partial compliance” including the “delusional belief” that “medication is poison.” What about when it is poison, or experienced as such? The image of the iceberg is also ambiguous. They are certainly suggesting that the exposed tip of the iceberg is the compliant, good, aspect of the patient, while the majority, bad, part remains beneath the water submerged in psychotic delusions. This still suggests a continuity between the upper and lower part, and an assertion that they do, in fact, represent the same whole human being. The image of the iceberg contains an image of power, since the submerged part is really where the base and strength of the iceberg lies. This second reading suggests that the whole patient is primarily hidden from the world, and that it is this hidden part where their true strength and power lies. That last word is no accident, for, when combined with the first reading of this ad, it is clear that the patient must lie about this hidden part if they want to keep it at all.
Zypprexa
Ad for Zyprexa, an antipsychotic. This ad contains has a number of disturbing visuals and text. Beginning with the top, it starts with “You’re trying to piece her life together” and follows this up with “She won’t swallow it.” This creates an “Us vs Them” framing that seems at odds with how medical treatment ought to be pursued. In the center, we see a woman pictured with a puzzle-piece hole where her mouth should be. The message is: the last thing missing to fulfilling her care is getting her to swallow Zyprexa. The word “Removing the obstacles to care” reinforces the message at the center of this whole arrangement: in order to help this woman, you must force her to swallow that which she will not. This is an extremely disturbing message in a patriarchal society, and is part of a visual culture utilizing and normalizing the imagery of forced acts perpetrated against women.
Haldol hallucinating.png
Ad for Haldol. The picture is pretty standard fare. We see a women colored with “trippy” or “weird” colors, next to what looks like it could be a smiling Satyr mask. One thing it would be interesting to examine more extensively would be the reliance on pharmaceutical ads and other visual representations of psychosis on images from the Western artistic canon. We often see satyr masks, images from Renaissance painters, or Surrealist paintings. The words “Consider the advantages of starting her on Haldol” again produces a “you” acting on “her” like the image above.
calling mom
This ad for Seroquel implies the impossible correlation between the level of the dosing and how often they call their mother, i.e. “come out of their illness.” Graphs like this are a beloved tool in the hands of those with no possible quantitative data to back up their claims.

*Some of these were found in my own independent research, but many were retrieved from The Bonker’s Institute here.

5 Comments

  1. Reblogged this on The life, writings, photography, and spiritual journey of Dithreabhach and commented:
    “You can’t set her free”: Pharmaceutical Advertisements and the Always Shifting Perceptions of Madness
    Looking at the ways in which the psychiatric profession advertised for its drugs and treatments can tell us a lot about shifting perceptions of mental health. We’ll keep the explanations short here, but if you want a more thorough critique of psychiatry, read our article Schizo-Genesis // Mad Apocalypse: the Story of the Psycho here.

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