Mania: A Short History of Bipolar Disorder

Mikkel Borch-Jacobsen writes:

How did we come to apply such a serious diagnosis to vaguely depressed or irritable adults, to unruly children and to nursing-home residents? Is it simply that psychiatric science has progressed and now allows us to detect more easily an illness that had previously been ignored or misunderstood? David Healy has another, more cynical explanation: the never-ending expansion of the category of bipolar disorder benefits large pharmaceutical companies eager to sell medications marketed with the disorder in mind. Psychiatric research doesn’t evolve in a vacuum. Behind the psychiatrists’ constant redrawing of the map of mental illness in a sincere effort at better understanding, there are enormous financial and industrial interests that steer research in one direction rather than another. For researchers, mental illnesses are realities whose contours they attempt to define; for pharmaceutical companies, they are markets that can be redefined, divided up and extended in order to make them ever more lucrative. The uncertainties of the psychiatric field present a magnificent commercial opportunity, since illnesses can always be tailored to sell a particular molecule under a particular patent. This is what industry insiders call ‘condition branding’. As Vince Parry, the president of an advertising agency and author of professional articles on pharmaceutical marketing, puts it, ‘No therapeutic category is more accepting of condition branding than the field of anxiety and depression, where illness is rarely based on measurable physical symptoms and, therefore, open to conceptual definition.’

(LRB 7 October 2010)