[BOLUWAJI OGUNYEMI] 1
ELECTRONIC SUBMISSION
FOR CONSIDERATION IN THE
UNIVERSITY OF TORONTO MEDICAL JOURNAL
The Role of Pharmaceutical Companies in the Medicalization of Mental Illness
Boluwaji A Ogunyemi1, BSc.
1
Faculty of Medicine, Memorial University of Newfoundland,
300 Prince Phillip Drive, St. John’s, Newfoundland & Labrador, Canada
b.ogunyemi@mun.ca
ABSTRACT
Medicalization refers to when behavior once considered a valid deviation from the norm is
subsequently deemed pathological and handled under the purview of medicine. The increasing
availability and use of screening tests as well as identification and dissemination of risk and
protective factors for disease lends itself to produce the “health-obsessed” society that North
America has become. Regarding the etiology of medicalization, critics have pointed their fingers
at a number of sources: medical practitioners and the dominance of allopathic medicine have
taken a lot of the blame in the past.
The medicalization of mental disorders has a history fraught with controversy because diagnosis
can often be a function of availability of pharmacological treatment with a concomitant potential
for profit. Scientists and clinicians employed specifically by pharmaceutical companies have a
heavier hand than one might think in framing what constitutes mental disorders – many of which
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respond reasonably well to the same medication that the companies manufacture. Advertising
by multinational pharmaceutical corporations affects the way that society thinks of disease.
Considerable portions of the revenue of support groups for particular mental disorders can be
traced back to pharmaceutical companies. The dominance of biomedicine as a paradigm as well
as changing societal norms have a part to play in the medicalization of mental disorders.
Medicalization is a socially-mediated phenomenon and medicalization of psychiatric disease
especially so. Political and economic forces temper the way society as a whole sees disease
and the role of pharmaceutical companies in the medicalization of mental illness is a prime
example of this.
KEYWORDS: Medicalization, Psychiatry, Mental Illness
MANUSCRIPT
Benjamin Franklin [1706-1790] may have had it backwards; rather than necessity being the
mother of invention, it seems all too often that the opposite is true. The role of pharmaceutical
companies in the medicalization of mental illnesses is largely an example of supply-driven
demand in which the providers and creators of medication frame the nature of illness in their
favor.
Medicalization is a term used to denote the process of otherwise normal behaviour being
treated as a medical entity and thus requiring treatment or otherwise taken under the purview of
medicine. Medicalization as a phenomenon
has been growing rapidly in industrialized
countries.. When treated under the scope of medicine, having a “disease” allows for doctors and
other health professionals as well as scientists to redefine, re-evaluate and relay information
about the condition; since the term medicalization first came into the literature in the 1970’s by
Boluwaji Ogunyemi
Irving Zola, Peter Conrad and Thomas Szasz. Moynihan et al [12] have it correct when they
state that, since the time of the first descriptions of medicalization, the social construction of
illness is largely being replaced by the corporate construction of disease. This is especially true
of illnesses of psychiatric nature.
Medicalization has been increasing with the greater availability of both treatments and
drugs. There are considerable economic costs of medicalization, especially with a decline in
socialized medical care and pharmacy care. Of course it is precisely the fact that
pharmaceutical companies can and have been financially prosperous that it is in their interest to
medicalize mental illnesses.
Since the 1990’s, pharmaceutical companies have adopted more aggressive corporate
strategies through increased mergers-and-acquisitions an increased emphasis of marketing and
considerable effort into research-and-development including employing and working with a
plethora of scientists and physicians. The latter two points will aid to delineate the ongoing role
of pharmaceutical companies in the medicalization of mental illnesses.
The medicalization of mental disorders is one of the most widely understood and
contentious instances of this phenomenon. The ever-increasing cases in the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a
testament to this. Indeed, the DSM has grown from 106 entries in its first publication in 1952 to
364 entries in the current version; DSM IV. (Table 1)
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Table 1: Editions of Diagnostic and Statistical Manual of Mental Disorders
DSM Version
Year of Publication
Number of entries
DSM I
1952
106 (130 pages)
DSM II
1968
182
DSM III
1980
265
DSM IIIR
1987
292
DSM IV
1994
297
DSM IV TR
2000
365 (886 pages)
DSM V
May 2013
To be confirmed
There are a variety of reasons for the increase between 1952’s DSM I with 106 conditions
and the current DSM IV (2008) which enlists 365 conditions; including but not limited to
increasingly valid criteria to test for disease, including those of psychiatric origin, increasing
ability to recognize abnormal behaviour and/or a biopsychological basis for said behaviour or
symptoms. Pharmaceutical companies are not innocent here either; according to Moynihan et
al, close to half of the authors that contribute to the expanding DSM versions have had a
relationship with a pharmaceutical company at some point. [12]
With
regard
to
mental
disorders,
many
critics
of
medicalization
advocate
paramedicalization: the replacing of the traditional biomedical approach of medical or clinical
emphasis in treatment of illness with a more holistic approach towards attaining health.
Paramedicalization includes counselling, meditation and discourse.. Stein et al. relate that with
reference to diagnosing cases of ADHD and depression, there is a wealth of data to show that
Boluwaji Ogunyemi
individuals are suffering from psychological problems and there are some cases that elicit
“universal agreement” of interpretation of symptoms. The author then goes on to state that
physicians are gaining more awareness of these conditions and that they can be “targeted by
modern medical interventions.” It is possible that these “modern medical inventions” are not
allowing clinicians to be more “aware” of disease but are actually creating the classification of
disease itself. This speaks to the technological imperative; the tendency for physicians to
employ new technology when they are available. [5]
In The Medicalization of Society, Conrad speaks to the role of publications and those of
Paul Wender and Frank Wolkenberg in particular, in the medicalization of adult ADHD. These
two spoke of their unfortunate experiences with adult ADHD and reinterpreted their lives before
the diagnosis. Later, Dr. Alan Zametkin, a psychiatrist at the National Institute of Mental Health
(NIMH)
published an article describing how a PET scan confirmed biological differences
between victims of adult ADHD and the rest of the “normal” population. (Conrad, 2007) After
these publications gained mass readership, adult ADHD clinics were created at Wayne State
University in Detroit, MI and at the University of Massachusetts in Worcester. Here, society’s
clamour about the “newly discovered” adult ADHD and the growing trend of becoming a riskbased society served in the increasing medicalization of mental illnesses. Many disconfirming
studies of Dr. Zametkin’s study were subsequently published, but did not gain mass attention
from the media; adult ADHD was already established. [3]
It is impossible to ignore the role of pharmaceutical companies in medicalization of
mental illness. Ciba-Geigy manufactures Ritalin, which is the most widely-prescribed treatment
for ADHD and adult ADHD. Ciba-Geigy provides considerable monetary support organizations
that support victims of ADHD. Moreover, “Ciba-Geigy as long been involved in framing
hyperactivity and now ADHD as a medical disorder.” [3] In 2005, 22 percent of the support
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group Children and Adults with Attention-Deficit/Hyperactive Disorder’s (CHADD) revenue came
from Ciba-Geigy. [3] Pharmaceutical companies have likely played a role in the increases of
stimulant use in America from 1995-2005 that has estimated between seven- and nine-fold. [3].
To be sure, the vast majority of cases of psychiatric disease that have been validly
diagnosed are genuine and would exist whether or not these corporations exist and therefore in
these cases treatment is entirely warranted and appropriate. The phenomenon of medicalization
belongs to medical sociology, as it describes those cases and characteristics that are not black
and white in terms of disease or non-disease in which society systematically constructs as
disease.
The same is true for social phobia. Though there are many instances of individuals who
suffer from this biopsycholgoical illness, if pharmaceutical companies had their way, almost
anyone would suffer from and therefore be able to benefit from treatment from social phobia.
The
pharmaceutical
company
Roche
promoted
an
antidepressant
named
Aurorix
(moclobemide) as a treatment for social phobia and the public relations department for this
company concomitantly issued a press release, announcing that over a million Australians (of a
population of 20 million) were suffering from social phobia.
The increase of consumer-directed advertisements in the United States has helped to
bolster medicalization of mental illnesses; pharmaceutical companies see individuals more so
as consumers than patients. It has been well-documented that advertisements create “wants.”
Advertisements that purport that the prevalence of social phobia is high and that individuals will
no longer be missing out on valuable relationships if they consider medication for the illness that
they have are created by pharmaceutical companies in conjunction with consumer agencies and
Boluwaji Ogunyemi
medical experts to make as many people as possible believe that they need medication to treat
their social phobia.
British sociologist Steven Yearley’s Actor-Network Theory provides one explanation for
the process of pharmaceutical companies and medicalization of mental disorders. According to
said theory, a group of actors or “truth-persuaders” undergo a series of steps to medicalize a
phenomenon. This begins with problematization of the condition, followed by using different
techniques to construe that a condition is not a valid deviation but indeed a genuine illness.
Then, the enrolling of individuals and avenues such as the media to be on the side of the
proponent of medicalization and finally mobilizing said parties must occur. [2] This enrolment
stage may also include publications to play a large role in the medicalization of Adult ADHD.
The media also acts as a significant conduit to which pharmaceutical companies benefit from
medicalization. The tenets of this theory are precisely in line with the function of many
pharmaceutical corporations.
Ceigba-energy promoting ADHD and adult ADHD support groups is an example of
problematization- ensuring that awareness of the disease is present. The role of truth
persuaders is often taken on by “medical experts.” There are many medical “experts” hired by
pharmaceutical companies that will speak to the prevalence of mental illnesses and other
diseases. To this end, it has been identified that between a quarter and one half of the
psychiatrists that are involved in the publication of the DSM have received part of their income
directly from pharmaceutical companies at some point. In both of these ways, medical experts
are being recruited to problematize mental illnesses. The media can also be recruited by
pharmaceutical companies to in this problematization phase, as described for the case of social
phobia.
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As another example, Upjohn and Solvay, a Belgian pharmaceutical company that
manufactures Luvox, a psychotropic medication for the treatment of obsessive-compulsive
disorder (OCD). This company created brochures to appear in doctors’ offices about the
possibility of having obsessive-compulsive disorder and fully funded patient education
programs, further intensifying the visibility of obsessive-compulsive disorder. Indeed, the more
people think they have disease the more disease will be found.
A spokesperson for Glaxo-Smith Kline, one of the giants in research-based pharmaceutics
states that "PR [public relations] and media activities are crucial to a well-rounded campaign;
particularly in the area of consumer awareness." With the help of medical experts, the media,
psychiatrists who write the DSM, consumer groups and a wealth of financial resources,
provider-driven demand manifests as pharmaceutical companies promoting the medicalization
of mental illness.
Yearley’s discussion on risk helps to delineate the fact that we have become a healthobsessed society and the relationship of this to medicalization. [2] Yearley states that modern
society has become less focused with the production and allocation of goods and services and
more concerned with the ascertaining and decreasing risk to harm. These harms include
pollution, the potential of radioactive contamination and of course, medical disease. In Making
Sense of Science: Understanding the social study of science, he states that “A society’s risk
anxieties relates as much to the cultural ‘insecurities’ of that society as to the actual extent of
hazards.” When this insight is applied to medicalization of social phobia, it is arguable that the
concern of having social phobia arising from media or other fora that pharmaceutical companies
employ may not stand to reason.
Boluwaji Ogunyemi
Roche has funded a number of conferences of social phobia and in this way stabilized this
condition as something that is prevalent and might affect any given person and more
importantly, can be treated by Aurorix, a psychotropic drug that Roche so happens to
manufacture. Around this time, Roche has hired clinical psychologists to speak to how
pharmacotherapy can ameleriorate social phobia.
Harry Collins’ [1943 - ] Empirical Program on Relativism is useful in delineating
medicalization. The main tenants in the theory are first understanding that scientific results are
not absolute but flexible, then analyzing the social processes that are involved with
interpretation of said results. The final stage in EPOR is investigating the influence of society as
a whole upon the scientists and physicians that both create classification of disease and
diagnose. [2] In our case, we find that the technological imperative is at least one value in the
medical community that promotes the medicalization of mental illness.
Emile Durkheim, one of the founders of sociology, states that society is “external” and
“coercive” and indeed it would be remiss to neglect the role of society in defining illness which is
in turn coerced by the impact of pharmaceutical companies. [13]
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REFERENCES
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[2] Yearley, S. Making Sense of Science: Understanding the social study of science.
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[3] Conrad, P. The Medicalization of Society. Baltimore: Johns Hopkins University Press;
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[11] Hu, S, Pattatucci, A, Patterson, C, Li, L, Fulker D, Cherny S., Kruglyak , L, Hamer, D.
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