Mental health in modern society is constantly getting worse. What do big pharma companies have to do with that?

Hundreds of years ago we didn’t know much about mental illnesses. In the 19th century, there were no actual mental disorders, instead, people were categorised into four groups and described as either feeble-minded, idiots, imbeciles or morons.

In the 20th century, tackling mental illnesses took on a multi-layered approach. Psychoanalysts would offer treatment by listening and talking through a person’s background; sufferers would be offered cognitive behavioural exercises in order to overcome their disorder, or you were prescribed drugs.

These days there are over 200 classified mental disorders, which include depression, anxiety disorder, schizophrenia, bipolar disorder and dementia.

Suffering from a mental disorder is more common than you might think, with an estimated 54 million Americans reporting symptoms.

However, some people think that we have gone from under-categorising to over-egging the diagnoses when it comes to identifying new mental disorders. One glance at the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) might explain why.


DSM-5 is the go-to book when it comes to new mental health diagnoses. It also happens to give important information to doctors and psychiatrists when treating patients who may be suffering from these mental disorders, i.e. prescribing drugs.

In the latest version, the DSM-5 added 15 new mental disorders, these included caffeine withdrawal, restless legs syndrome and premenstrual dysphoric disorder.

It is these seemingly odd diagnoses that has caused speculation as to what the DSM’s motives are.

The DSM describes caffeine withdrawal as the withdrawal that occurs after ‘any abrupt cessation of caffeine intake’, but classing this a mental illness has raised criticisms. Those who concur with the DSM argue that caffeine is a mild stimulant and taking too much and then stopping quickly will have some effect on the body. However, those that disagree state that this classification has more to do with insurance claims than it does diagnostics.

As for restless leg syndrome (RLS), many people will have difficulty understanding how a physical condition such as RLS can be afforded a mental illness status. It does have a neurological basis, in that sufferers have raised activity of certain neurotransmitters in their brains. However, when you or I think of a mental disorder, would you naturally think of RLS?

Knowing where the DSM gets its information from in order to make these diagnoses might help us understand their motives.

The DSM gets the majority of its data from faculty psychiatrists who work and teach at highly-respected academic medical centres. Known within the medical industry as ‘key opinion leaders’ (KOLs), they are the ones who write the papers that strongly influence how conditions get diagnosed.

It is from these people that the DSM gets most of its material. Criticism has been levelled at KOLs, however, because of a lack of real scientific evidence to support these diagnoses.

Marcia Angell, a senior lecturer in social medicine at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, explains how.

When the DSM-II was published in 1980, it became “the bible of psychiatry,” writes Angell, who adds, “but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions.”

It appears that doctors were asked to identify certain disorders by the DSM by matching symptoms described by a patient.

Not only this but as psychiatry in general moved away from talking therapy and onto drug prescriptions for treatment, it has been revealed that of the 170 KOLs that contributed to the current DSM edition, 95 are have financial interests in big pharma companies. Coincidence?

The link between psychiatrists and the big pharma companies

Undoubtedly, psychiatrists and the drug companies make more money if they are doling out prescriptions than spending counselling time with their patient.

So could there be a direct correlation between the number of new mental disorder diagnoses and the amount of KOLs who have interests in big pharma companies? The more mental illnesses there are, the more drugs can be prescribed. Furthermore, unlike other branches of medicine, such as cardiology, where you cannot over-prescribe drugs, in mental health, it is possible to expand the area of a mental disorder, simply by using the word ‘spectrum’.

In the present day, we have left our multi-layered approach to treating mental illnesses and now favour psychiatric drugs. But how has this happened? First of all, a psychiatric disorder has to be catalogued, this is where the DSM and the pharmaceuticals come in. Big pharma companies tell you what is socially acceptable behaviour and what requires treatment. Nowadays, personal problems are defined as mental illnesses and, backed by the DSM and the pharmaceuticals, have to be kept under control with drugs.

And if you think this cannot happen, just think that decades ago depression was thought to be a reaction to a stressful life event, whereas nowadays most people view it as a chemical imbalance in the brain.

It appears that we are being encouraged to live in a relatively narrow spectrum of behaviour ourselves, with any aberrant activities consigned to a diagnosis of mental behaviour. And if the pharmaceuticals have anything to do with it, that mental behaviour is going to cost us.

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