Depression Lit Review
Depression: How does the marketing of depression affect public stigma of depression?
Introduction
Depression is increasingly recognized as a mental disorder by much of the world’s population. According to the World Health Organization, depression is expected to be the world’s second largest health problem, just after heart disease, by 2020 (Gordon). Also, the National Institute of Mental Health estimates that fourteen million Americans suffer from major depression, and more than three million suffer from minor depression (Menand). Although its causes are unknown, general practitioners usually associate depression with psychological causes, mainly stressors; medical causes, such as a chemical imbalance; and external causes, such as time of year (“You’re depressed…” 123). Increasingly, there has been a shift towards recognizing depression as a chemical imbalance in the brain by populaces across the globe, contributing to a huge increase in antidepressant sales over the last twenty years. Menand acknowledges that one out of every ten Americans holds a prescription for antidepressants, meaning there are thirty-one million prescriptions in the United States alone. This suggests over-prescription of antidepressant drugs. This over-prescription, and shift in public thinking can be contributed to drug corporations that partake in “direct-to-consumer” advertising, and demonstrates the ability large corporations have to influence public opinion (Menand).
Public Recognition/Stigma
There have been numerous studies completed throughout the world on how depression is perceived by the public. Link (1330) and Jorm agree that about 70% of the American and Australian public recognize depression as a mental illness. Other than recognition, public surveys commonly ask about negative and positive perceptions of depressed people. According to Crisp, Link, and Peluso, there were differences in whether the public viewed depressed people as dangerous, ranging from 22.9% (Crisp et al. 5) to 56.8% (Peluso and Blay 204). In addition, Wang (192), Angermeyer (180) and Crisp (5) claim that about half of the public in Canada, Germany, and Britain respectively, saw depressed people as unpredictable and felt uneasy around them. Also, according to Link, half the population of the United States wishes to maintain social distance from people with depression (1332), including not renting a depressed person a room, not introducing to friends, not recommending for a job, not wanting someone with depression to marry into the family, and not leaving a depressed person in charge of children (Angermeyer and Matschinger 180).
Although many surveys show negative stigma towards individuals with depression, Angermeyer and Matschinger concluded that 60% of the German public has more nurturing reactions towards depressed people, showing a desire to help (180).
Causes
There is disagreement among the public, those with depression, and even among professionals about what actually causes depression. There were four main categories of causes that appeared throughout surveys of the public and general practitioners: stressors, life events, constitutional, and character related. Stressors, such as work, family, unemployment, and the economy, were the most commonly cited causes by the public, ranging from 68.8% of the Swedish public (Hansson, Chotai, and Bodlund 56) to a huge 94.8% of the American public (Link et al. 1330). The next most cited causes were past life events, and similar discrepancies were discovered in the data, where the United States always had a higher percentage of the population citing these factors as causes (Hansson, Chotai, and Bodlund 56; Link et al1330) (Crisp 5). The biggest discrepancies however were in the citing of more constitutional causes. According to Hansson, a minority of people in Sweden cited constitutional causes (56), but a majority of Americans claimed depression was hereditary, with a very high 72.8% believing depression to be a chemical imbalance in the brain (Link et al. 1330).
Treatment
There are many types of treatment options for depression, including both pharmacological and non-pharmacological treatments. Jorm conducted an Australian public survey, and collected data on what people thought would be most helpful in terms of treating depression, and who would be more beneficial to turn to for help. Surprisingly, he discovered most people thought that counselors and family and friends would be most helpful, while only half the population cited psychiatrists and psychologists. Jorm’s survey reported that more people thought non-pharmacological treatments (exercise, getting out more, diet, relaxation practices, and learning about the problem) would be more effective than pharmacological treatments (vitamins and anti-depressants). According to Jorm, the most commonly reported non-pharmacological response was “getting out more” and was mentioned by about 82% of respondents, while only 29% of respondents listed pharmacological treatments, such as anti-depressants, as potentially helpful. Another survey compared responses of patients and general practitioners, finding that while general practitioners gave similar responses for psychological causes and non-medical treatment, general practitioners usually attached more importance to somatic symptoms, medical causes, and medical treatment (“You’re Depressed…” 123).
Over-prescription
Many medical professionals agree that antidepressants may be over-prescribed. According to Menand, depression may be over-diagnosed because of the lack of agreement on what depression actually is. The Diagnostic Statistical Manual just lists symptoms of depression, such as two weeks of a depressed mood, insomnia, and lack of interest in pleasure, allowing psychiatrists to diagnose people who are feeling temporarily sad (“Major Depressive Episode”). Menand argues that these symptoms are very broad and may lead doctors to a false diagnosis. To explain the vast number of antidepressant prescription holders, Monson and Schoenstadt acknowledge the fact that antidepressants can be used for purposes other than depression including anxiety disorders, OCD, PTSD, and panic disorder. Currie also acknowledges the multiple uses of antidepressants, but argues that drug companies themselves create new disorders which need antidepressant prescriptions, such as social anxiety disorder, in order to facilitate company growth (13). Currie also suggests that a lack of government regulation may indirectly lead to over-prescription of antidepressants (16).
Advertising
Pharmaceutical companies spend millions of dollars advertising their products each year. In some cases, Currie claims a more intensive advertising program can lead up to an increase in sales upwards of four times the amount spent on the advertisement itself (15). According to Menand, "There is suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry's direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off)”. While Currie may not argue that the pharmaceutical industry is “cooking studies”, she does contribute the increasing number of antidepressant sales to pharmaceutical companies’ advertising depression as a chemical imbalance (9). In terms of target consumers, both Currie and Emmons give evidence that the advertising of depression specifically targets women (8; Weinstein). According to Weinstein, Emmons further argues that drug companies make up new symptoms of depression, like “tearfulness” which have distinctly feminine connotations and characteristics.
While some experts, such as Emmons, accuse pharmaceutical companies of having selfish, profit driven motives, pharmaceutical companies argue that they take a more humanitarian approach. Most, if not all of the leading pharmaceutical companies such as GlaxoSmithKline and Pfizer specifically make some sort of reference to wanting to improve the quality of human life by applying science to improve global help. However, it is worthwhile to point out that GlaxoSmithKline does include a few pages on its website under its mission statement which state the companies top three goals were to “grow a diversified global business, deliver more products of value, and to simplify the operating procedure.”
Conclusion
Future research of depression will emphasize the effects of marketing strategies on public opinions regarding depression. Current and continuing research will also attempt to discover what the actual cause of depression is, and what treatments are most effective to combat it. Until then, pharmacological treatments may remain highly controversial and negative public stigma towards depressed individuals may persist.
Works Cited
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