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January 13th, 2009 - click opera — LiveJournal
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January 13th, 2009
Tue, Jan. 13th, 2009 03:29 am

"Utsu is the Japanese word for depression," proclaims a Helvetica caption in the elegant trailer for Mike Mills' 2007 documentary Does Your Soul Have A Cold? "Before 2000 utsu was seldom heard outside psychiatric circles. The concept of depression as a mental illness was virtually unknown in Japan... In 2000 the first Western pharmaceutical company began selling antidepressants in Japan. Utsu is now common knowledge."



I ran this "fact" past some Japanese friends. They all told me it wasn't true; that utsu was in fact a fairly commonly-used word long before 2000, and that anti-depressants had been advertised and sold in Japan since the 1960s.

Mike Mills repeats his thesis in this interview given when his film showed at SXSW in Austin, Texas: "Before 2000 they didn't really have a commonly-used word for depression, they didn't really know about depression, and they definitely didn't really know about it as, like, a mental illness that could be dealt with or cured or treated," Mills said. "And so companies like GlaxoSmithKline came in with these very large ad campaigns and website presence and symposiums and taught people about depression and their version of how to fix it."

But Mills adds a sort of disclaimer: "My film is more a portrait of five people who are taking anti-depressants than a heavy-duty reporting on GlaxoSmithKline or something like that." The story of a golden age before anti-depressants forms a kind of mythical backdrop to these five portraits. There are shades of the Garden of Eden and the Tree of Knowledge in his tale, but transposed to Japan; in Mills' telling, malaise is seen as a positive quality in Japanese folk stories, and Buddhism sees pain as an integral part of life. GlaxoSmithKline is the foreign snake suggesting the Japanese innocents bite into the apple.



Even if I'm a bit skeptical of the mythical backdrop to Mills' documentary, I think he's probably right about the lengths to which big drug companies are prepared to go to extend not just the definitions of mental illness into ever-more-normal areas of pain and anxiety, but also the categories of people they're prepared to prey upon. In a shocking article in the current New York Review of Books entitled Drug Companies and Doctors: A Story of Corruption, Marcia Angell exposes the kickbacks authoritative figures in US medical circles are receiving to whitewash new medications from major drug companies. She also shows how drug companies and professors of psychiatry like Dr. Joseph L. Biederman are encouraging doctors to diagnose children as young as two years old as "bipolar" and prescribe cocktails of powerful drugs.

"We are now in the midst of an apparent epidemic of bipolar disease in children (which seems to be replacing attention-deficit hyperactivity disorder as the most publicized condition in childhood)," Angell writes, "with a forty-fold increase in the diagnosis between 1994 and 2003. These children are often treated with multiple drugs off-label, many of which, whatever their other properties, are sedating, and nearly all of which have potentially serious side effects." Many of these drugs have never been approved by the FDA, and none of them have been approved for children below the age of ten.



There are parallels between the penetration of psychoactive drugs into new markets (Japan, children) and the mortgage crisis which triggered the great financial meltdown of 2008; in both cases sheer greed, aggressive marketing and spurious redefinitions have expanded markets in ways which delivered immediate new sources of profit, but also exposed everybody involved to new risks. Just as American banks were developing their ingeniously stupid No Income No Asset (NINA) mortgages, the mental health industry was developing criminally irresponsible No Illness No Effect (NINE, I guess) medications: drugs prescribed for perfectly normal types of sadness, and often no more effective than placebos. Angell describes how FDA reviews of the six most widely used antidepressant drugs approved between 1987 and 1999 -- Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor -- found that, on average, placebos were 80 percent as effective as the drugs.

This didn't stop GlaxoSmithKline from making $2.7 billion annually in sales of Paxil alone in 2004. Capitalism -- doesn't it make you sick?

The process by which drug companies expanded definitions of mental illness even to ordinary conditions of the human soul is covered well in Adam Curtis' BBC documentary series The Trap. Here are two excerpts from the series covering the invention of conditions like OCD, ADHD and PDSD:





Dr Robert Spitzer, the creator of a simple new diagnostic system based on yes / no responses to questions about surface symptoms, admits to Curtis that he may have over-diagnosed mental illness by between 20% and 30%. The computerised system, launched in 1979, came back with the startling "finding" that more than 50% of Americans suffered from some type of mental disorder: a "hidden epidemic".



Context was ignored; "we don't know the causes, but this is what these new conditions look like". The new conditions -- OCD, ADHD, PDSD, SAD -- were met, conveniently, by new drugs from the major drug companies, SSRIs like Prozac, which modified behaviour chemically. Spitzer's checklist became a powerful guide to what was considered normal and abnormal, and people came to doctors expecting prescriptions for chemicals which would take away perfectly normal, realistic and, in many cases, appropriate mental states like fear, grief, anxiety, disappointment and loneliness. Social problems were medicalised, political solutions tranquilised.

When the American adult market became saturated with these abnormality-defining conditions and the normalcy-bringing drugs associated with them, it was time to move on to new markets: children and -- apparently -- Japanese people.

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