In 2002, the American Psychiatric Association (APA) published a volume outlining the revisions to the Diagnostic and Statistical Manual, the DSM IV.
The APA had begun compiling the DSM IV in 1999 as the definitive text containing “discussions of such issues as to whether disease, illness, and disorder are scientific and biomedical concepts, or sociopolitical terms that necessarily involve a value judgment.”[i] One essay entitled, “Neuroscience Research Agenda to Guide Development of a Pathophysiologically Based Clarification System”, by Charney et al., is explicit with the fact that DSM IV definitions “are virtually devoid of biology, and are merely based on clusters of symptoms and characteristics of clinical course.”[ii] The DSM IV itself states that the definitions of mental illness are self-created and lack biological backing. Ideas of what the true “natural” self is comes from the indoctrination of a certain style of thought and speech executed by those that society has deemed as credible in such matters. “This sort of thought in biological psychiatry not only establishes what counts as an explanation, it establishes what there is to explain.”[iii]
In “Neurochemical Selves”, Nikolas Rose claims “[psychiatric] drugs do not so much seek to normalize a deviant but to correct abnormalities, to adjust the individual and restore and maintain his or her capacity to enter the circuits of everyday life.”[iv] Between the years of 1990 and 2000, the United States saw an eight-fold rise in the number of cases of prescribed psychiatrics. By the end of the decade, the United States spent a reported $19 billion on psychiatric drugs, nearly 18 percent of a $107 billion pharmaceutical industry.
A marked example of “purchased personalities” is visible in the rise of diagnosed cases of children with Attention Deficit Hyperactivity Disorder, ADHD. In 2004 it was reported that between 1996 and 2003 Scotland saw an increase of prescriptions of Ritalin, the pharmaceutical treatment for ADHD, from 69.1 to 603.2 per 10,000 children.[v] The rise of diagnosed cases of ADHD is a classic example as to how the labeling of a behavior as problematic, and not as variation among individuals, leads to higher rate of diagnosis of specific created disorders.
Societal creation of norms and reinforcement through advertising affects individual perceptions of normality. Within the United States, the combination of ADHD awareness campaigns targeted towards doctors, and the inclusion of ADHD as a behavioral problem that would merit schools with additional federal funding drove the rise in the diagnosis rate of ADHD in the 1990’s, all of which was funded by the pharmaceutical companies. While one might expect that forceful application of defining how a “true” child behaves would be meet with opposition from parents and schools, research has shown that the inverse has happened. Parents have begun to lobby for “their” problem of active children and speak frequently of the drug “as enabling the child to take control of him or herself, restoring the child to his or her true self again.”[vi] 
Coupled with societies acceptance of physician and pharmaceutical definitions of normality, medical imaging technology has increasingly played a vital role in the diagnosis of deviance. Where other body parts and organs had been objectified earlier in history, as evident in artistic representations of the body as machinery with interchangeable parts 
, the development of the frontal lobotomy by Egas Moniz in the 1930’s ignited a cultural shift in physicians thinking of the brain as an organ. Like other organs, the brain performed a specific function and, like machinery, was liable to break down. Moniz based his work off of previous work that had been conducted on monkeys and chimpanzees that noted the calming effects of the destruction of the frontal lobe of the brain. In 1936 Moniz developed techniques that he preformed on human subjects.
First he destroyed the frontal lobe by injecting alcohol directly into the brain. Later he developed a technique that surgically cut nerve fibers. Walter Freeman and James Watts developed similar techniques. They entered the brain through the eye with the aid of a tool that resembled an ice pick.
By 1948 lobotomies had been executed on about 20,000 patients worldwide, and by 1949 Moniz had been awarded the Nobel Prize in physiology for his work.[vii] “These techniques were linked to a new way of visualizing the brain as a differentiated organ traversed by neural pathways with specific mental functions amenable to localized intervention.”[viii]
Medical imaging technology has certainly advanced since Moniz’s days yet the visual interpretation of illness is still interpreted by physicians who are culturally qualified. Rose tells the story of Leigh Anne, a patient who was diagnosed with severe depression after the birth of her first child. Initially she was prescribed Prozac and began psychotherapy sessions. Her symptoms were elevated after several weeks of therapy and discontinued her therapy regime after several months. For several months after the stoppage of her therapy she remain relatively happy. When the symptoms returned Leigh Anne was reluctant to go back on to Prozac, she associated the use of the drug as the actions of a sick person 
. Only after her physicians performed a brain study and presented her with visual evidence, that was only readable to her via translation 
, was she was convinced that she did in fact need to go back on medication.[ix] “When mind seems visible within the brain, the space between person and organs flattens out-mind is what the brain does”[x]
As mentioned in the conversation about ADHD, advertising has changed the publics’ relationship with disease. While Leigh Anne had been reluctant to continue the use of medications and was only convince through foreign visual aid, the advertising of pharmaceutical drugs has given a new angle to the culturally indoctrinated power of the media by “enabling” 
patients to take control of their own health by self-prescribing. Through “direct-to-consumer advertising” pharmaceutical companies “…suggest to individuals that that their worry and anxiety at home and work might not be just because they are worriers but because they are suffering from a treatable condition.”[xi] By encouraging viewers to asses their health from a list of possible symptoms and by advising them to talk to their doctor about starting treatment on a specific “designer” drug the viewer is convinced that they are taking an active role in the monitoring of their own health and are able to function more accurately within society.
But when did it become wrong to worry, or to be sad? Sadness is a natural emotion to be experienced within the course of life. If we never experience sadness how are to understand our own happiness?
Why can’t examining and attempting to change the cause of our sadness ascertain normal happiness? From personal experience, seeing family members refusal to accept that certain events had taken place has led to them taking anti-depressants. What happened to “talking things out”? When confronted about these certain events this family member denies that they ever happened. While the rest of the family has accepted reality and moved on to find happiness with out the aid of anti-depressants, the one living in denial still struggles and needs psychiatrics to feel their “true” self.
An ethics is engineered into the molecular makeup of these drugs, and the drug themselves embody and incite particular forms of life in which the “real me” is both “natural” and to be produced. Hence the significance of the emergence of treatments for mental ill health lies not only in their specific effects, but also in the way in which they reshape the ways in which both experts and lay people see, interpret, speak about, and understand their world.[xii]
[i] Nikolas Rose, “Neurochemical Selves,” in The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Centaury. (Princeton: Princeton University Press, 2007), 206.
[ii] Rose, 207.
[iii] Rose, 192.
[iv] Rose, 210.
[v] Rose, 209-210.
[vi] Rose, 211.
[vii] Rose, 195.
[viii] Rose, 196.
[ix] Rose, 197.
[x] Rose, 198.
[xi] Rose, 213.
[xii] Rose, 222.
Images Cited:
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