Contents

The Medicalization of Distress

Major Depression in the DSM-IV/V

The American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) defines Major Depressive Disorder (MDD) as a depressed mood or loss of interest and/or pleasure in daily activities for more than two weeks, including changes in mood and function in social, occupational and educational domains. Specific Symptoms are listed in a series of nine criteria whereby five must be met for an individual to receive a diagnosis of MDD. In addition, the DSM-V adds more specific domains including family relationships, academic and work, peer relationships, stress level & anxiety, suicidal ideation, and other self-harm, and assesses the severity in terms of impairment.


DSM-1V Criteria for Major Depressive Disorder (MDD)
1. Depressed mood or irritable most of the day, nearly every day (e.g., feels sad or empty)
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness
8. Concentration is diminished or more indecisiveness
9. Suicidality

Incidence of Depressive Disorders

Depression is estimated to affect 350 million people worldwide. According to the National Institute of Mental Health, the World Health Organization (WHO; 2010) claimed that major depression is the most common mental and behavioral disorder. In 2015, it was estimated that 16.5 million adults 18 or older in the US were diagnosed with at least one depressive episode within the past year, representing 6.7% of all U.S adults[1]. In addition, The Canadian Mental Health Association claimed that about 8% of adults in Canada experience major depression at some time in their lives[2]. Not only does major depression affect the lives of many adults but also adolescent and young adult populations, ranging from ages 15-24 years, whereby suicide accounts for about 24% of all deaths among this demographic and above leading up to middle aged adults. By the year 2020, the World health Organization predicts that Major Depression will be the second greatest International Burden of Disease ranking [3].

Causes & Reasons for the Depression Epidemic

Political and Economic Influences

Awareness of the epidemic of depression is advocated via preventative strategies, de-stigmatization campaigns, and an increase in resources and funds for treatment and research. Although, these campaigns and foundations are seen as positive in helping to those cope with depression, they also facilitate and sustain the business and industry of depression as a mental illness. As a result of these corporate funded public health strategies there has been greater public acceptance of the disorder and an increase in the support for the coalition of doctors, researchers, advocacy groups, drug and pharmaceutical companies, and other benefited corporations.

Drug Companies and Pharmaceutical Benefits of Depression

Elevated rates of Major Depression, as well as other categorical mental disorders, have served the interest of the pharmaceutical industry in improving their profits and expanding their market for depression and other mental illness by funding public depression awareness campaigns, medical education and research regarding treatment with the use of pharmaceutical drugs.[4] Despite the appearance of 'doing good', these medical industry attempts to increase public awareness of depression and facilitate drug treatment and prescription by medical physicians is largely self-serving to these companies. The pharmaceutical industry has significant influences in clinical practice guidelines, research, and authors of the research and information distributed and disclosed to the public. Ninety percent of authors whom contribute to the Journal of the American Medical Association have significant connections to the pharmaceutical industry [5]. In addition, the pharmaceutical industry spends about 36% of its revenue on public advertising including via the Internet Antidepressants are the most commonly used drug treatment for those with depression despite many studies that have shown the drugs lack of effectiveness as compared with placebo experiments [6]. Although severe cases of depression may require antidepressants as a last resort, mild cases of depression often begin initial treatment with the prescription of drugs, which can lead to a poorer outcome for these patients and a higher risk of negative side effects [7].

Summary

Description
English: The Pharmaceutical Industry has a huge political and economical influence on the default prescriptions and over-prescription of antidepressants and other drugs by physicians regarding the the treatment depression at any signs of distress in the everyday life of individuals.
Date 8 December 2016(2016-12-08)Template:Date-time separatorTemplate:Formatting error Template:Resize
File source http://www.nairaland.com/1290326/how-start-pharmaceutical-importation-buisness
Author Nairaland

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Influences of Broadening 'Depressive' Symptoms of the DSM on Commonality

Depressive symptoms including, sadness, insomnia, appetite or weight changes, tiredness, apathy, and lack of concentration are symptoms that everyday people may experience regarding social situation. However, these depressive symptoms make it difficult to avoid a depressive diagnosis, thereby increasing the epidemic of depression. Depression is as valid and real as it was in the 19th Century as it is today, yet we see far more individual’s being diagnosed with depressive disorders as the diagnostic criteria of Major Depression in the DSM has broadened over the years, allowing normal responses of sadness to situational variables to fit the criteria of a mental disorder, such as depression. [8]

https://www.youtube.com/watch?v=M6lHSXPWF68

Problems with Pathologizing Distress

The Biomedical Model of Depression

The Biomedical Model is the dominant model in which mainstream psychiatric medicine uses. It explains depression as a chemical imbalance within the brain and therefore implies that we can predict, treat and control depressive illnesses with quick fixes using antidepressant drugs such as Selective Seratonin Reuptake Inhibitors (SSRIs). However, There is more to the explanation to depression than simply neurophysiology and biology. Depression tends to be a recurring and/or chronic condition that has a multifactorial causation including the interaction of social, psychological and behavioral factors. Problems with the mainstream Biomedical model is that it reduces depression to simply a biological explanation, despite its complexity, and influences people's inclination to the medical treatment of pharmaceutical drugs which may be harmful rather than helpful to individuals with mild or moderate depression [9]. The Biomedical model may increase stigmatization and the development of a self-concept in accordance with the diagnosis of depression by reducing one's explanation of depression as something internal to them, their biology or neurology [10]. Antidepressant drugs may provide short-term relevance of some symptoms of depression but reliance on these drugs to do so can make an individual subject to a self-identification as helpless and reliant on the services of health care professionals and the medical system. Rather, reducing their diagnosis of depression to social factors that are external to them, depression is more likely to be de-stigmatized and is perceived by patients who suffer from depression as more treatable[11] . A recent meta-analysis of various alternative treatments concluded that St. John's work, exercise, light therapy, and self-directed cognitive treatment were as effective as antidepressants in mild to moderate depression[12].

Labeling Theory of Mental Illness

People are seen and see themselves as mentally ill or depressed, rather than as individual's who have or suffer from such disorder. The diagnosis of depression may become a label that is often associated with a stigma and thus, may lead to an alteration of self-concept according to such diagnoses. Depression is associated socially with a negative construct or stigma, by which if such a label via diagnosis is given to an individual, the individual often begins to define his or her own self-concept according to the negative construct that depression entails. Therefore, Diagnosis leads to social and self-stigma which can lead to non-adaptive coping strategies in response to such negative self evaluation, which can lead to a reduced self-esteem, and overall negative self-concept [13].. Often times people who are diagnosed with depression, and other mental disorders, seek medical treatment from experts resulting in the definition themselves according to their diagnosis and acceptance of the diagnosis into their self-schema as a part of who they are. This can influence a self-fulfilling prophecy in which individuals with depression behave a certain way that is consistent with their diagnosis of depression that has been integrated into their self-concept, in turn providing support and creating a positive feedback cycle for this belief of the self[14].

Solutions to reducing the Depression Epidemic

Perception of Distress Influenced by the Pharmaceutical Industry

The perception individual's distress diagnosed as a standardized mental illness ignores the individualized experiences and/or traumas that one may have suffered. Labels such as depressed render individual's previous experiences as meaningless denoting them to a simple categorical, medical diagnosis[15]. In perceiving sadness and other criteria of depression in the DSM as simply a medical diagnosis we de-humanize individuals and deduce their emotional pain to pharmaceutical treatment. The perception of mental illness tends to have a negative stigma attached to it. However, mental turmoil is a frequent reaction that most individuals experience within the highly active and stressful pressures of the modern world. Contrary to perceiving distress and depression with an incline to categorize, diagnose and treat with pharmaceuticals, we may begin to approach depression and other instances of distress with counselling therapies such as Cognitive-Behavioral Therapy. Psychological therapy can provide an opportunity for long-term solutions to conquering the epidemic of depression, getting to the root of one's stressors and reasons of depression-like symptoms, without the need for surface level 'quick-fixes'[16]. Nonetheless with this being said, some individuals do indeed experience the need for pharmaceutical drugs to resolve chemical imbalances of the brain. Even so, those who may have predisposed neurological imbalances can benefit from both prescription drugs as well as psychological therapy in reducing depression symptoms [17]. However, the over prescription of anti-depressant drugs and over diagnoses of depression in response to everyday distresses contributes to this cycle of depression. As the pharmaceutical industry continues to have political and economic control over the research, diagnostic criteria and training of physicians,the epidemic of depression will also continue. In addition, as drug treatments also continue to be the most common form of prescribed treatment, which often requires long-term use, the pharmaceutical industry will in turn continue to benefit and obtain control over the perception of depression by society and the protocols of depression according to the medical system. Thus, the perception of depression in society and by active physicians in the medical system continues to be influenced by the pharmaceutical industry, which seems to have a huge responsibility in the overall depression epidemic.

References

  1. Major Depression Among Adults. National Institute of Mental Health. (2015). https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
  2. Candian Mental Health Association. (2016). Fast Facts about Mental Illness.http://www.cmha.ca/media/fast-facts-about-mental-illness/#.WEIILEvxUb0
  3. Mulder, R. T. (2008). An Epidemic of Depression or the Medicalization of Distress?Perspectives in Biology and Medicine 51(2), 238-250. The Johns Hopkins University Press. Retrieved December 2, 2016, from Project MUSE database.
  4. Conrad, P. (2007;2008;). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.
  5. Wattignar, D., & Read, J. (2009). The pharmaceutical industry and the internet: Are drug company funded depression websites biased? Journal of Mental Health, 18(6), 476–485.
  6. Wattignar, D., & Read, J. (2009). The pharmaceutical industry and the internet: Are drug company funded depression websites biased? Journal of Mental Health, 18(6), 476–485.
  7. Mulder, R. T. (2008). An Epidemic of Depression or the Medicalization of Distress?Perspectives in Biology and Medicine 51(2), 238-250. The Johns Hopkins University Press. Retrieved December 2, 2016, from Project MUSE database.
  8. Hidaka BH. (2012). Depression as a disease of modernity: explanations for increasing prevalence. Journal of Affective Disorders, 140(3), 205-214. doi:10.1016/j.jad.2011.12.036.
  9. Mulder, R. T. (2008). An Epidemic of Depression or the Medicalization of Distress?Perspectives in Biology and Medicine 51(2), 238-250. The Johns Hopkins University Press. Retrieved December 2, 2016, from Project MUSE database.
  10. Gawley, A. M. (2007). “Depression is a medical condition”: Exploring the medicalization of depression on SSRI websites (Order No. MR35233). Available from ProQuest Dissertations & Theses Global. (304715246). Retrieved from http://ezproxy.library.ubc.ca/login?url=http://search.proquest.com.ezproxy.library.ubc.ca/docview/304715246?accountid=14656
  11. Cheng, Z.H. Asian Americans and European Americans’ stigma levels in response to biological and social explanations of depression. Social Psychiatry and Psychiatric Epidemiology. (2015). 50(5), 767-777. doi:10.1007/s00127-014-0999-5.
  12. Mulder, R. T. (2008). An Epidemic of Depression or the Medicalization of Distress?Perspectives in Biology and Medicine 51(2), 238-250. The Johns Hopkins University Press. Retrieved December 2, 2016, from Project MUSE database.
  13. Pasman, J. (2011). The Consequences of Labeling Mental Illnesses on the Self-concept: A Review of the Literature and Future Directions. Social Cosmos, 10(1).
  14. Harris, M. (2005). Self-fulfilling prophecies in the clinical context: Review and implications for clinical practice. Applied and Preventitive Psychology. 3(3), 145-158.
  15. Edited by Mark Rapley, Joanna Moncrieff and Jacqui Dillon . (October 2011). De-Medicalizing Misery . Retrieved from http://www.palgraveconnect.com.ezproxy.library.ubc.ca/pc/doifinder/10.1057/9780230342507.0001
  16. Conrad, P. (2007;2008;). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press.
  17. Thomas-MacLean, R., & Stoppard, J. M. (07/01/2004). Health (london, england : 1997): Physicians' constructions of depression: Inside/Outside the boundaries of medicalization Sage Publications.

[1]

  1. Mulder, R. T. (2008). An Epidemic of Depression or the Medicalization of Distress?Perspectives in Biology and Medicine 51(2), 238-250. The Johns Hopkins University Press. Retrieved December 2, 2016, from Project MUSE database.