This subscribers-only article at the London Review of Books by Mikkel Borch-Jacobsen about bipolar disorder is pretty good. It looks at how the invention and definition of the condition has changed over the decades, and also how it was launched.
David Healy, the author of the book being reviewed, estimates that around 0.001 per cent of the population were diagnosed with the condition around the turn of the 19/20th centuries (based on admission charts from a Welsh asylum. But:
In 1994, for example, the US National Comorbidity Survey estimated that 1.3 per cent of the American population suffered from bipolar disorder. Four years later, the psychiatrist Jules Angst upped the figure to 5 per cent: 5000 times higher than the figure suggested by Healy. And yet we continue to be told that bipolar disorder is merely a new name for the old manic depression. Are we really talking about the same thing (the realist hypothesis)? Or did the name create a new thing (the nominalist hypothesis)?
That’s the context, and it’s all interesting, but this next bit really caught my eye, about how a new disorder can emerge through the launch of journals, papers, conferences, PR agencies, etc…
Healy tells the story of the launch of bipolar disorder at the end of the 1990s. A specialised journal, Bipolar Disorder, was established, along with the International Society for Bipolar Disorders and the European Bipolar Forum; conferences were inundated with papers commissioned by the industry; a swarm of publications appeared, many of them signed by important names in the psychiatric field but actually ghost-written by PR agencies. Once the medical elites were bought and sold on the new disease, armies of industry representatives descended on clinicians, to ‘educate’ them and teach them how to recognise the symptoms of bipolar disorder. Bipolar patient advocacy groups sprang up, generously supported by pharmaceutical companies; freelance journalists were hired to write magazine articles on the latest advances in psychiatric science; websites were created, such as IsItReallyDepression.com (sponsored by AstraZeneca), where you can fill out a ‘mood assessment questionnaire’ at the end of which you’ll inevitably be dispatched to the nearest doctor. As a British blogger noticed recently, the Wikipedia entries ‘Bipolar Disorder’ and ‘Bipolar Spectrum’ were edited from a computer belonging to AstraZeneca, ensuring that everyone is on the same diagnostic page as the industry.
After this marketing blitz, it was no longer possible to ignore bipolar disorder. A new reality emerged, constructed by scientific articles, patient testimonials, rating scales, statistics, epidemiological surveys, clinical guidelines, everyday language (‘I’m bipolar’), vague fears and reassuring medications. ‘It is essentially like setting a snowball rolling down a hill,’ a Practical Guide to Medical Education intended for industry marketers explains. ‘It starts with a small core of support: maybe a few abstracts presented at meetings, articles in key journals, focuses for discussion amongst “leading experts” … and by the time it reaches the bottom of the hill the noise should be coming from all sides and sources.’ Pharmaceutical companies today launch diseases in the way that fashion companies launch new brands of jeans, creating needs that align with industrial strategies and the duration of patents.
The techniques Healy describes are the same as those used by the pharmaceutical industry to sell, or oversell, conditions as diverse as depression, social phobia, metabolic syndrome, attention-deficit/hyper-activity disorder, fibromyalgia, premenstrual dysphoric disorder, panic attacks, restless legs syndrome and so forth. In each case, the existence and risks of one condition or another are amplified in order to persuade us to swallow chemical products that may be either useless or, often, potentially toxic.
(None of which is to diminish the condition’s real symptoms of course — the article is more nuanced than these snippets make it appear.)