September 9, 2009

"Are there really so many people with such troubles in your country to make such medicine such an important matter?"

flag.jpgA reader writes:

"I'm from Europe, speak about a medicine intended to declare/sell that medicine as "mood stabilizer"... However, are there really so many people with such troubles in your country to make such medicine such an important matter? I didn't think of America as being such a sad/depressed country and a medicine called "mood" something seems to me such a stretch..."

How I wish I had made this up.  The email closes:

I'd be glad if I knew you'd think about it for a moment... how sick your country appears from the outside when one reads about so many medicines and so many disorders and about medicine for .... anything slightly uncomfortable. And how all these trendy things migrate to other countries, where people don't even know that their moods, sadnesses, uncomfortable moments, their life in a word, is a disorder.
Here's my answer:

The short answer to your question is: yes, there are many such patients here in the U.S.  However, most of these "patients" do not need these medications, most do not need psychiatry at all.  Of course many do, they are truly sick and but for psychaitry their lives would be chaos.  But the majority do not.

But they come to psychiatry because they are told, almost constantly, that there is something wrong with them.  That the fatigue they feel, the emptiness, the lack of interest or sexual appetite or sadness or irritability-- all of these things could be helped by medications. 

It happens that these "symptoms" occur in the absence of a clear cause, and medicines do help.  But the majority of the time these are symptoms only because they are compared to someone else.  Testosterone patches are the new big thing in psychiatry.  No, I'm not kidding.

I'm not sure what a lack of sexual interest in a 40 year old is-- but certainly in comparison to any TV show, it's going to seem low.  That preys on people-- a man worries that his wife is judging him, even as she is worried he is judging her; so both are worried, essentially, that the other person has agreed to accept TV as normal and feels consequently inadequate.  Etc.  If you doubt this, watch two married people try to sit through a sex scene in an episode of Sex In The City, or Mad Men, etc, together.  They're both going silently insane.

They are handed images of life-- TV, etc-- and they think that they are supposed to be that.

The complicated answer to your question is that American society isn't really capitalist, it's mercantilist.  Americans don't want riches, they want what they are told to want.  They don't want a nice car: they want a Lexus.  They don't want a nice house; they want a Viking refrigerator, granite counters.  They don't want nice things: they want things that represent nice things.  Americans want brands.  While everyone was orgasming over The Tipping Point, they should have been reading this.

As such, psychiatry isn't a field serving a need; it is a product creating a market.  They didn't need treatment; they were told they needed treatment.  Just like you don't need Nike shoes, you're told you do.  Granted, having Nike shoes or psychiatric treatment can still be helpful, but most can certainly get along without it and, dare I say it, neither is worth the price.

And when someone says, "I didn't really want Nike shoes, I just got them because they were on sale," they have inadvertently proven my point.  You bought them and you didn't even want them, they were the default.  "But I needed to buy some kind of shoe."  Think it through...

Psychiatry-- medicine-- is too gigantic of an industry to bend to the whims of reality.  It will create a market because too many people's economies depend on it.  It's too big for Obama or anyone else to change it.  Fox News and MSNBC can yell at each other all they want, it's already been decided: Wellpoint's stock has soared since Obama rolled in.  The "public option" is now Aetna.

This is how it has always been throughout history.  Did Europeans really blast cannons at each other in the 16th-17th centuries because people desperately needed more spices?  Yes, they actually did.  A third of the Triangular Trade was rum.  People died over rum.  Not depleted uranium or alien artifacts or the Spear of Longinus: rum. 

You ask whether it is worrisome that the rest of the world might see American as a bunch of invalids.  Well, that maybe true: but what do we care?  We're the only people that matter, all other people are supporting cast.

Your final point is the most important:  All of this is coming to a town near you.  All of this nonsense talk about whether American is losing its global dominance is a ruse.  As long as America remains the largest current market, it sets the standards.  The Chinese are going to want to need Viking refrigerators.

True power rests in the hands of those who define our cultural models and decide what we want to need or who we want to pretend to be.

The history of the world is the history of mercantilism; the history of men bending government to fight to the death for things they don't really need and only barely want.