How Drug Companies Helped Shape A Shifting, Biological View Of Mental Illness

How Drug Companies Helped Shape A Shifting, Biological View Of Mental Illness

Terry Gross

Prior to the 1970s, Harrington says, society tended to distinguish between forms of depression that should be treated medically versus depression caused by "bad stuff going on in your life," which was thought to be treated best by talk therapy.

But as pharmaceutical companies began to market antidepressant drugs, the focus of treatment for many people moved away from talk therapy. Harrington says this shift has not always served patients well.

"We don't know enough about the biology of these mental disorders to know whether or not some of the reasons are biological — in the sense that medicine likes to think of these things as diseases — and whether it's just because they're having terrible problems," Harrington says. "I would love to see a larger, more pluralistic set of options."

Interview Highlights

On why the patient pool for anti-anxiety medications grew so much in the late '70s

There had been an enormous market for anti-anxiety medications. ... In 1978, I think something like 2.2 billion pills of Valium were sold in one year. It was the bestselling prescription drug of all time in the 1970s. And it was an anti-anxiety medication, but then it turned out it was addictive, and people couldn't get off it. The market for the benzodiazepine plummets. But where are these people — what are we going to do for these kinds of patients?

Well, it had long been known that one of the symptoms of depression was often anxiety. And so it became possible to think, "Well, maybe these patients who were previously being diagnosed with anxiety, in fact, suffer from depression with acute anxiety presentation, and maybe the antidepressants will help." And they did. And so you've got the expanding pool of people suffering from "depression." You've got the emergence of depression in the way we think about it now — as the common cold of psychiatry.

You've also got a development in which there's a collapse of a previous distinction that the field had made between forms of depression that should be treated medically and forms of depression that were seen to be neurotic or reactive, that were caused by bad stuff going on in your life, and that it was widely thought should therefore be treated with talk therapy. But if medication helps everybody, then maybe these distinctions, some say, aren't so important; maybe what's more important is the severity of the symptoms. And at some point, the symptoms are severe enough [that] medication might then be what you choose to prescribe the patient.

But it doesn't mean that the drugs don't work. It just means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing, and you have to be able to be better than nothing. But, of course, if the placebo effect isn't just nothing, then maybe you need to rethink what it means to test a drug. Now, this sort of goes beyond what historians should be talking about, but it does seem that the pharmaceutical company has a big placebo problem on its hands.