“You can’t set her free”: A Visual Essay on 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.
[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 Schizo-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
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.
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.
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.
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.
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.
*Some of these were found in my own independent research, but many were retrieved from The Bonker’s Institute here.