The Age Of Anxiety (2012)

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Transcript
00:00People are becoming more and more anxious.
00:04More than a third of us feel the world is a more frightening place than it used to be.
00:09By age 32, 50% of the population might qualify for an anxiety disorder.
00:15For an estimated 10 million Americans, fear of social situations can be totally debilitating.
00:22I'm a 40-year-old man in a 12-year-old body.
00:25One of my friends said, for people like you, we used to pour buckets of cold water on them as they lay in bed.
00:30That's what you deserve.
00:33If they can fix their anxiety with a pill,
00:37that's just as appealing as discovering that you can make your dinner with a microwave oven.
00:42The country is bathing itself in prescribed drugs.
00:47There are many, many unhappy people out there in the real world.
00:50They don't all have psychiatric illnesses.
00:53The ultimate risk now is that we've psychiatrized the entire population.
00:58We've ended up in a situation where virtually everybody has some kind of disorder.
01:01That's crazy.
01:14The number one prescription people come to the pharmacy for is anxiety.
01:19Wouldn't you say about three quarters of what we have here is for anxiety, Mark?
01:23About three quarters of the things in the pharmacy are for anxiety.
01:26It's kind of a sad thing. It's a tragic thing, really.
01:29This is a story about a society on edge.
01:34A place where our culture, the very way we live, is leaving us feeling more anxious than ever before.
01:42We're normally anxious because life is dangerous.
01:45Many of us are vulnerable to losing a job or being underemployed.
01:50We can't manage whether we're going to get a disease or not most of the time.
01:55The other factor I think is really important is isolation.
02:00So that sense that really nobody does have your back.
02:04The collapse of meaning so that, you know, where we all used to sort of, you know,
02:09trudge off to the same church and even if we didn't explicitly believe in God,
02:13if we had a general consensus about it, now we have none of that.
02:17So that's very anxiety-provoking.
02:20Once considered an obscure and serious illness, anxiety is now a big part of our cultural identity.
02:28Eighteen percent of the U.S. population is said to have an anxiety disorder.
02:33So that's pretty high, certainly higher than depression, higher than bipolar disorder, higher than schizophrenia.
02:40Modern life is taking its toll. Anxiety about terrorism, increasing fear of crime.
02:46More than a third of us...
02:47You can't avoid hearing about anxiety if you're in a media-sophisticated setting.
02:53Sixty-six percent say the economy is contributing to our fears.
02:57And I think in a setting like that, we become socialized to those ideas.
03:02All over the world a sort of psychiatric perfect storm has been brewing.
03:07New diagnoses for anxiety, prescription-happy GPs, and a hectic society
03:14have all collided in the early 21st century to effectively turn us all into mental health patients.
03:24More and more people who have normal worrying anxiety are being diagnosed as having a mental disorder.
03:29It's become extraordinarily prevalent in our culture as a reference point
03:34for how we're all feeling without us necessarily understanding what it is that we're talking about.
03:41What has changed? Or has anxiety always been with us and only now taking its place in the cultural spotlight?
03:52To answer that question, we need to know, what exactly is anxiety?
03:59So often there's a confusion in the minds of people when they're speaking.
04:03When they're talking about anxiety, are they talking about something normal?
04:08Are they talking about something extra-normal?
04:10Are they talking about something pathological?
04:13Is it a disease? Is it a symptom?
04:17The dictionary describes it as a feeling of worry, nervousness, or unease,
04:23typically about an imminent event or something with an uncertain outcome.
04:28In reality, it means very different things to different people.
04:35A welling up of what I used to call panic juice.
04:39I know that sounds weird, but it felt like there was this volcano of panic juice
04:44coming from the stomach and then into the rest of me.
04:47It kind of feels like something's always chasing you.
04:50That you are always trying to get away or always trying to get somewhere.
04:54There's something always right behind you, coming for you.
04:58It's just something your brain does to you.
05:01It's something you see that triggers the brain, like the alarm, it goes off.
05:06I thought my heart was stopping.
05:08I'm going to not lie to you, I thought my heart was stopping and I thought I was going to die.
05:12I thought my heart was stopping.
05:14I'm going to not lie to you, I thought my heart was stopping and I thought I was dying.
05:19That may sound a little crazy, but I'm not lying.
05:25It's not a productive fear, it's more of a paralyzing fear.
05:34Well, there's just everyday anxiety.
05:37Missing the subway when you're late for work.
05:40Trying to get to an appointment and you can't find a cab.
05:44It's just, the city is fraught with it.
05:47The experience varies because anxiety occurs on a spectrum.
05:52At one extreme, it's a crippling disorder.
05:55At the other, a normal, even healthy part of daily life.
06:00The anxiety is not all bad.
06:02Think about how in college did you keep yourself up late at night studying for that test to get a good grade?
06:08Actually, it was anxiety that got you to do that.
06:12It's normal to be anxious, which is a form of fear.
06:16It's just a fear of what's going to come in the future.
06:19However, when that fear or that anxiety becomes disconnected from the situation,
06:25let's say there is no danger in the environment and you are still worried, still anxious, still fearful,
06:30that's when we are talking about anxiety disorders.
06:33Sometimes I'd look at ordinary objects and it would cause me to be,
06:38just stimulate a panic response.
06:41I'd look at a teapot and be afraid of it.
06:43Why would you be afraid of a teapot?
06:46I get the same kind of feeling someone would get waiting outside their exam room for the test,
06:53but I have it all the time.
06:56If you can see the tiger through the brush and you're fearful,
07:00hey, that's a rational response.
07:03If you know the tigers have been dead for a thousand years and you're still fearful of them,
07:07then that's anxiety.
07:11I was watching a TV show and I saw something about someone choking
07:16and nobody did anything to help them and it scared me.
07:19I went to bed the next night and then the next morning I was afraid to swallow.
07:23I don't know, it just freaked me out really.
07:27I couldn't eat because I was afraid I was choking and then I was going to die.
07:31And then eventually we went to a psychiatrist and I was diagnosed with anxiety.
07:37Today, people like Aaron and Lucas, who meet the criteria of an anxiety disorder,
07:42are most likely to end up on medication.
07:46But as the conversation about life's daily anxieties grows louder and louder,
07:51more and more people who think of themselves as normal
07:54are considering using pills to deal with everyday life.
08:07For me, anxiety is not having control over my life in any environment.
08:14I'm at work and my shoulders are up here and I literally have to say,
08:18down, down shoulders, you know, because they're up at my ears.
08:27I don't know how I'm managing.
08:29You're kind of not.
08:30I'm not.
08:33And especially when you have a four-year-old and, you know,
08:37we're looking into schools for her now.
08:40And private schools.
08:42We are looking into...
08:43And is Alan working?
08:44No.
08:45Excellent.
08:47OK.
08:49He was laid off right after the crash in 08.
08:52So we have one income and a mortgage and, you know, it's very difficult,
08:58especially living in New York City.
09:02There are a lot of people competing for your job.
09:04There are a lot of people competing for that seat on the subway.
09:08There are a lot of people who get to the farmer's market before you do
09:13and buy up all the corn that you were going to cook for your guests that night.
09:20I heard a story about parents dropping off their kids
09:23and sort of clogging up the street in front of the school
09:27and they weren't dropping off correctly.
09:30And eventually they had to be threatened with putting a mark
09:34on their child's permanent record.
09:37And this was a preschool.
09:40I still sometimes have trouble sleeping
09:43and I still sometimes have some hyperventilation.
09:47I have a lot of tension in my... I clench my teeth a lot
09:50and it's destroying my teeth.
09:53The traditional gender roles are kind of reversed in my household,
09:56so I think that's another thing that plays into it is that, you know,
10:00I'm not the mommy that a lot of other kids have.
10:05I'm the one who goes to work every day
10:07and she sees basically an hour a night and on weekends.
10:13You feel completely helpless.
10:15You feel like you have no control over your own life.
10:19We get ourselves into a situation where we think that we're rational
10:22and that we can have perfect control over our experience.
10:25And then when we lose control of that experience,
10:28which of course we're going to do because there's so many other elements involved,
10:31it's terrifying.
10:34We are pushing ourselves to the edge of our confidence and competency
10:39and the result is that somebody who thought before,
10:42well, I'm going to be OK, I can just keep myself cool and collected,
10:45now they're so freaked out and so stressed
10:47that they're going to reach for, if they're offered,
10:50which they often are by a GP, they'll say,
10:52yeah, you know what, maybe I better take a pill
10:54because I really need to keep my cool here.
10:59According to the World Health Organization,
11:01disorders related to dread
11:03are now the most prevalent mental illnesses on the globe.
11:08On the one hand, we all are anxious.
11:10Right now I'm anxious about whether my car's parked outside
11:13and who's going to get a ticket or not.
11:15But anxiety is also a pathological emotion
11:18and that is not a normal experience because anxiety can be crippling.
11:27I would get heart palpitations,
11:29I would have this tightness in my chest
11:31and not really understand what was happening, losing my breath.
11:35I just had no idea what was going on.
11:44Kendra Fisher was on her way to a spot on the Olympic hockey team
11:48before anxiety began to take control of her life.
11:53It's this secret you want to keep
11:55and this thing that you don't want people to know you're dealing with.
11:59To then have to try to explain to people
12:01why I wasn't okay going out for dinner,
12:03I wasn't okay driving down the street.
12:06It got to a point where I wasn't okay leaving my apartment.
12:10I lost about 47 pounds in a month and a half.
12:13I couldn't eat, I couldn't sleep.
12:16I was just an absolute shell of myself.
12:20When her condition became unbearable,
12:22Kendra was forced to retire from hockey
12:25just weeks before realizing her dream of joining Team Canada.
12:30It was the one thing that I had spent my entire life wanting
12:35and where do you go after that?
12:40Since touching bottom several years ago,
12:43a mixture of meds, psychotherapy and lifestyle changes have steadied Kendra.
12:48But she's still unable to dine out in public
12:51or go to a concert without risking a serious attack.
12:56Heaven forbid I forget to take my pills
12:59and that typically makes for a rough day.
13:03Today, an extreme case of anxiety like Kendra's
13:06is treated as a genuine psychiatric illness.
13:09While someone like Jessica, for now at least,
13:12falls just under the threshold of a disorder.
13:16What separates them is still for the most part a scientific mystery.
13:21In the 17th century, if you were anxious or depressed,
13:25then it was thought to be the result of demonic possession.
13:31This then leeches away and by the end of the 18th century,
13:35the population as a whole has stopped believing in demonic possession
13:39and has started believing in clinical medicine.
13:43Anxiety was seen as an aspect of psychotic illness.
13:48That means the presence of delusions and hallucinations.
13:52Early cures varied from spa treatment
13:55to special diets, prayer, even fresh air.
13:59But then the huge change in medical interpretations of anxiety
14:03comes with a psychoanalyst, comes with Sigmund Freud.
14:07When Freud says, yes it is very much a disease of its own, anxiety neurosis.
14:12Treatment was evolving too.
14:15Spas and physical therapies gave way to barbiturates
14:18that produced sensations from mild sedation to total anesthesia.
14:23These were the first psychoactive drugs.
14:26Barbiturates, the sleeping pills, bear colorful names like goofballs,
14:30red devils, yellow jackets, blue heavens and rainbows.
14:34Pet pills and sleeping pills, when improperly used,
14:38can be just as dangerous as taking dope.
14:41By the 1960s, Valium-style drugs, the benzodiazepines, had taken over,
14:46partly because they were considered less dangerous.
14:50And since the late 1980s, the Prozac family of drugs, or SSRIs,
14:55have dominated treatment for anxiety.
14:58These work, in theory, by increasing the level of serotonin in the brain.
15:03We have no idea how it works. Somehow you take it every morning,
15:07and your anxiety goes away.
15:09What does it matter that we don't know how it works?
15:12One of the issues is that there are many side effects,
15:15and the less that we know about how drugs work therapeutically,
15:19the less we're going to know about how they may work
15:23to cause negative or adverse reactions.
15:27For all of its many forms,
15:29anxiety is still not easy to see with the naked eye.
15:33Today, millions in research dollars are spent on neuroscience,
15:37in the hopes of finding the next big breakthrough.
15:41All right, so what we have here is we have an animal
15:43that's been implanted with fiber optics,
15:45directed at a part of the brain called the hippocampus,
15:47that we think is important for anxiety-like behavior.
15:51This maze measures the animal's innate anxiety,
15:53and its innate fear of open spaces.
15:56When we keep the light off, the animal will behave like a normal person.
16:00When we keep the light off, the animal will behave like a normal mouse.
16:03It'll basically spend all its time in these closed parts of the maze.
16:08When we turn on the light and activate these specific circuits,
16:11the animal will now start to explore the open arms of the maze.
16:15That suggests that we can regulate the animal's anxiety state.
16:19And so if we can discover new circuits in the brain,
16:22we can now create better drugs to alleviate anxiety in humans.
16:26While researchers try to map anxiety in the brain,
16:30the search is on for the genes that trigger it all.
16:34Psychiatric disorders run in families,
16:36and that basically tells you that there is a vulnerable genetic terrain
16:40in certain individuals.
16:43We are only at the top of the iceberg.
16:45We've found a few of the genes involved,
16:47but probably more than 90% are still missing.
16:51For now, anxiety is understood basically as a list of symptoms.
16:56Observed by patients and doctors, and collated since 1952,
17:01in what's known as the Bible of psychiatry,
17:04the Diagnostic and Statistical Manual of Mental Disorders,
17:07or simply the DSM.
17:10The role of the DSM is really very simple.
17:13It's a long list of mental disorders,
17:17and it helps us to locate our patients
17:22within that spectrum of psychological suffering.
17:26We can't take a brain picture, and we have no blood test,
17:30to tell us, oh yes, this is anxiety.
17:33We depend entirely on patients telling us how they're feeling.
17:38The most important function of the Diagnostic Manual
17:41is to set the boundary between normality and psychiatric illness.
17:45Now the trouble with this is that there is no clear boundary.
17:50Already, vague definitions of anxiety in the DSM
17:54make it easy to over-diagnose.
17:57Homosexuality used to be in the DSM.
18:03In New York, Jessica Scott has been reading the DSM
18:06out of curiosity about her own anxiety.
18:10Tonight, she's decided to self-diagnose with her friends
18:13and see how many of them meet the threshold of an anxiety disorder.
18:19I'm curious though, let's take a look in the DSM.
18:21This is the Diagnostic Criteria for Generalized Anxiety Disorder.
18:27So let's see what it says, and let's see what we think about it.
18:31Because now everything's a syndrome.
18:34A. Excessive anxiety and worry, apprehensive expectation,
18:39occurring more days than not for at least six months.
18:42Forty-five years.
18:48All right, who wants to read the next two of these?
18:50Because this is giving me a headache.
18:52Restlessness or feeling keyed up or on edge.
18:55Check.
18:56Easily fatigued.
18:58Yes.
18:59Difficulty concentrating or mind going blank.
19:02This is perimenopausal.
19:03Well, that is also perimenopausal.
19:05Muscle tension, sleep disturbance, difficulty falling or staying asleep,
19:10all of the above.
19:11Okay, so here's the thing.
19:12Everybody in the world has been experiencing anxiety.
19:17So what's the label that we're all experiencing?
19:20Well, for you it's...
19:23Generalized Anxiety Disorder.
19:26Is that for you?
19:27Yeah.
19:31Using the DSM to diagnose anxiety at a dinner party is, of course,
19:37far from an exact science.
19:39But the same is true even for the professionals
19:42in a case where the patient is genuinely on the fence.
19:46Can I turn left out of here?
19:48Oh, a bike.
19:49Jesus.
19:50Oh, don't do this to me.
19:52Oh, my God.
19:53If I have to focus, I can't.
19:55I can't listen to anything.
19:56I can't have anyone talking to me.
19:58Driving is a big one.
20:01Like everybody experiences anxiety over exams and stuff,
20:04but I think I experience it a little bit more.
20:08I don't know if it's a little bit more or the same
20:11or I don't know if people are better at dealing with it than I am
20:13or I don't know.
20:16My name's Stephanie.
20:17I was wondering if I could talk to one of your counsellors.
20:19Sure.
20:20Anxiety on the campus is huge.
20:22We'll see in the neighbourhood of about 11,000 students in health service,
20:26about 28% of all the students that we see have an anxiety disorder.
20:30Little things will set me off.
20:32And my first lab of this year, I, like, spilled reagents all over myself
20:36because I did my calculations wrong.
20:38And the worse I do, the more I freak out,
20:40and it just sort of compounds.
20:42The fact that I'm even thinking about medication is strange for me
20:47because I don't like taking it.
20:49Because we expect to be more happy and fulfilled
20:53than the average human life is going to be,
20:56we start to become open to the idea
20:59that our unhappiness is somehow pathological or a disorder
21:03and that it deserves to be treated.
21:06And that's a real modern phenomenon
21:08to take the complexity and enormity of human emotion
21:12and turn it into a treatable illness.
21:15If you have an illness that can be corrected with a new boyfriend
21:20or a check for $5,000,
21:22then you probably don't have a psychiatric disorder at all,
21:25even though you'll be given a psychiatric diagnosis today.
21:30I would definitely say most students,
21:32we're probably looking for an easy way out
21:34because there's so much that's expected of us.
21:36Like, a lot of people have a job
21:38while they're going to school full-time
21:40and having to pay off loans and things,
21:42and I know people that are getting second degrees,
21:44so they're paying off their student loans from before
21:46while getting more student loans.
21:48So I can see people like,
21:50well, I can take this pill and it'll be gone in 30 seconds,
21:53or I can do this exercise for 30 minutes.
21:55I can see why people would find that to be the easy way out.
21:58They'll come in having researched on the internet,
22:01they'll read into what symptom profile they believe that they have,
22:05and they'll say, well, this is what's prescribed,
22:07this is what is recommended, and I'd like to get that.
22:10We have students coming in asking for specific drugs.
22:13So you seem a bit nervous to me even right today.
22:16I have a little bit of social anxiety.
22:20They're overwhelmed. It's kind of this vague overwhelmed.
22:23They feel that they can't meet their deadlines,
22:26that there's just too much work, they don't know where to start.
22:29I can cope most of the time, or at least I try to,
22:31but it's getting to the point where it's just too much and I can't.
22:34What you have to realize is that it's in a continuum.
22:37There is the normal adaptive response, and when it gets exaggerated,
22:41you fall into the anxiety disorder.
22:44But there is an arbitrary cutoff between the two.
22:49In the majority of cases in the anxiety disorders,
22:52all I have is your report to me,
22:55and so that creates a little bit of subjective problem.
23:01Because of that subjectivity, anxiety is easy to over-diagnose.
23:06At the same time, GPs are often too busy to look beyond medication for the answer.
23:13Drug companies understand this better than anyone,
23:16and they spend a fortune marketing to doctors and consumers alike,
23:20trying to bring us all under the pharmaceutical umbrella.
23:24It's like I can't participate in life.
23:28It's like I can't participate in life.
23:30I'm too busy worrying. I don't sleep at night.
23:33Paxil works to correct this imbalance, to relieve anxiety.
23:36I think what's happened over the course of the last 30 years
23:39is a kind of perfect storm in psychiatric diagnosis.
23:42The most common symptoms include rapid heartbeat,
23:45trembling, sweating, tense muscles...
23:48People have to understand that these diagnoses
23:51that one hears on every street corner
23:54are diagnoses that are being marketed for commercial profit.
23:58They don't necessarily correspond at all to what your underlying problem is.
24:05Medicalization is a huge, huge issue,
24:07and psychiatry is the easiest area to medicalize
24:10because we don't have the biological gold standard.
24:14The country is bathing itself in prescribed drugs.
24:19There's already an enormously high rate of diagnosis of anxiety disorders.
24:24In a recent study, it turned out that by age 32,
24:2850% of the population might qualify for an anxiety disorder.
24:32Get that. Age 32, 50% of the population might qualify for an anxiety disorder.
24:38To qualify, patients must meet the criteria published in the DSM.
24:44It's a document that is always being revised.
24:47Often to include more and more symptoms and new diagnoses.
24:52It's a trend that worries former chairperson Dr. Alan Francis.
24:57It seems like the system is way too loose already,
25:00and what DSM-5 is suggesting is to open the gates way wider
25:04and make it much easier to get an anxiety disorder.
25:08There's a new proposal for a diagnosis of mixed anxiety depression
25:13that would be, I think, very much equivalent to the everyday worries,
25:17tensions, stresses, problems that all people have.
25:21And this is likely to become, from nowhere,
25:24the most common diagnosis in psychiatry.
25:28This would be a needless increase of psychiatric diagnosis,
25:32a medicalization of normality,
25:35making pathological the worries and troubles
25:38that are a natural part of the human condition.
25:41And that we shouldn't turn routinely into a medical disorder.
25:45One of the doctors charged with reviewing anxiety disorders for the new DSM
25:50is Helen Blair Simpson.
25:53Mixed anxiety depression is a hotly contested issue.
25:57This is something that people worry about.
26:00And there's always that sort of balance between
26:03how do you make sure someone who's ill gets the diagnosis,
26:07and how do you make sure that someone who's not
26:10ill doesn't.
26:13This session really continues the road to DSM-5.
26:17Perhaps the most important psychiatrist in the world today
26:21is Dr. David Kupfer.
26:24As chair of the DSM-5 task force,
26:27he is the man with the final say on what will be
26:30and what won't be a mental illness.
26:33What we all were asking ourselves to do
26:36was to basically look at everything that was in the DSM-4
26:41and say, if it's working well, leave it alone.
26:45Nobody has been instructed to look for more,
26:48to look for more disorders.
26:50We are making changes because we believe
26:53that it will serve us better
26:55in terms of dealing with patients and families.
26:58I think that the DSM-5 has an important job to do,
27:02but it's doing just the opposite of what I would be suggesting.
27:05I think that the appropriate function of psychiatric diagnosis now
27:09should be to try to tame the tiger,
27:12to try to indicate in the manual, with big black box warnings,
27:16this diagnosis is being overused.
27:18Here are the key steps to making sure
27:21that you're making this diagnosis appropriately.
27:23Instead, what DSM-5 is doing is opening the floodgates.
27:26The number of diagnoses in the DSM system continues to increase.
27:30In reality, if you look at the different forms of illness,
27:33there are only 4 or 5 major forms of psychiatric illnesses.
27:37There aren't 400.
27:39This is a classic conflict between the splitters and the lumpers.
27:42The splitters are people who say we must make
27:45ever more finely differentiated distinctions
27:48among kinds of behavior that we consider to be pathological.
27:52The lumpers say, well, you know,
27:54there are only about 4 or 5 things that can really go wrong.
27:57I'm very much a lumper, but the future belongs to the splitters.
28:03Imagine a society in which all the new disorders
28:08currently proposed for the DSM-5 were accepted
28:12and became real diagnoses to be used in everyday medical practice.
28:22They'll go from period to period, from decade to decade,
28:25from saying homosexuality is a disorder,
28:28to saying, you know, overeating is a disorder,
28:30to saying whatever the thing of the day is
28:32that people are not necessarily comfortable with,
28:35that they may decide is disordered.
28:37So in this funny, funny way,
28:39we've actually compartmentalized our entire sort of human personality
28:44into billable coding systems.
28:49For example, my wife died on March 6th of this year, OK?
28:53I had a grief experience after that.
28:56The symptoms I had, couldn't sleep, didn't want to eat,
29:00felt a lack of energy, sad, those are the symptoms of depression.
29:05Now, it used to be that we said that after a year of grief,
29:11if you still had those symptoms,
29:14then you have a depression, not grief.
29:18What do we say now?
29:20We say after two weeks of the death of a spouse, a child or a parent,
29:25if you still have those symptoms,
29:28you can be diagnosed as having depressive disorder.
29:31It's very clear to me that it's not a question
29:34that too many people are getting too much treatment.
29:37I think to some extent there are a lot of people
29:39who are not getting enough treatment,
29:41and I worry more about that, to be honest with you.
29:46A new diagnosis in psychiatry is dangerous
29:49because tens of millions of people may get medicines
29:52that previously they wouldn't have gotten,
29:54and those medicines may not be helpful.
29:56The biggest beneficiary of diagnostic inflation
29:59is obviously the big pharmaceutical companies.
30:02You'd have to be stupid as a manager in the pharmaceutical industry
30:06not to realize that your bread and butter is coming out of the diagnosis.
30:12Thinking about what the pharmaceutical industry will do or not do
30:16is not primary on the agenda of the task force,
30:20the work group members, etc.
30:22We have no control over how, if you will,
30:27companies or researchers or organizations spend their money.
30:33I think that's the disconnect,
30:35and they don't feel sufficiently responsible
30:37for the public health unintended consequences
30:40of the decisions they're making.
30:42They're thinking of the consequences only in their practice.
30:44They're not thinking about the unintended consequences in the real world.
30:49Unintended consequences,
30:51like creating a disease where none existed before.
30:55That's the story of Paxil,
30:57notorious as the landmark case
30:59in the multi-billion dollar game of drug marketing.
31:04Well, it was orchestrated by GlaxoSmithKline's PR firm.
31:08It was a very concerted, very well-planned effort
31:13to publicize this disorder.
31:16For some people, the fear of interacting with others.
31:19In fact, any social contact is so acute
31:21that they go out of their way to avoid all social situations.
31:24This is a condition known as social anxiety disorder.
31:27In the 19th century, shyness was a virtue.
31:30It was considered to be a sign of character and of good breeding.
31:35In our times, shyness is a pathology,
31:38and we go to some length treating shy people as if they were sick.
31:44Well, are they really sick?
31:46Or has the pharmaceutical industry discovered
31:48it can make money off of treating shyness?
31:51The thought of public speaking can send butterflies
31:54for someone suffering from a phobia.
31:56Tense muscles, upset stomach.
31:58It can actually make living a day-to-day life almost impossible.
32:01I remember seeing all these stories coming out
32:04kind of at the same time in many different publications,
32:07and it was about this social anxiety disorder.
32:09They all contained these fantastic statistics
32:12saying, you know, what percentage of Americans
32:14suffered from this disorder in any given year,
32:17and a lot of them contained the same experts
32:20and patients talking about the disorder.
32:23Studies have shown that Taxol can dramatically decrease
32:26the symptoms of social anxiety disorder.
32:29And so I was kind of curious about, well, that's strange.
32:32All of a sudden, out of nowhere, you know,
32:34all these stories start popping up at once.
32:36What's going on with that?
32:38Brendan Korner began his investigation
32:41by trying to find out who was behind
32:44all these news reports he was seeing on TV.
32:47When I would trace back the phone numbers they listed,
32:50I would see they would trace back to PR firms
32:53that just happened to represent GlaxoSmithKline,
32:56which was the manufacturer of Paxil,
32:59which just coincidentally had just been approved
33:01to treat this disorder.
33:03Turns out they weren't real news reports at all.
33:07Conan Wolfe, Glaxo's PR firm,
33:10was hired to produce a series of video news releases,
33:14easy enough to mistake for the real thing,
33:16and sent them anonymously to TV stations across the U.S.
33:21The good news for the millions with this disorder
33:24is a medication called Paxil, just approved by the FDA.
33:27It is the first and only FDA-approved treatment
33:30for social anxiety disorder.
33:32The company then hired, you know, PR companies
33:36and other companies to encourage doctors
33:39to become, quote, educated, which was, it was really marketing,
33:44and to encourage the public to reframe shyness into a disorder.
33:50Paxil also developed a quite cynical strategy of ghostwriting
33:56whereby they contacted physicians
33:58and helped them create stories
34:00that could be plugged into the medical literature.
34:03So they buy credibility by the use of an academic.
34:09It's clear there was a lack of disclosure
34:11and real efforts on the part of the PR firm
34:14to obfuscate the fact that this was ultimately
34:19something propelled by a company looking to sell a product.
34:23Before the publicity strategy started,
34:25there were 51 media stories around the world.
34:29One year after the campaign had started,
34:32focusing on the concept of imagine being allergic to people,
34:37there were 1.5 billion stories in the media.
34:40So it's remarkable how this became a kind of a societal concept.
34:46GlaxoSmithKline's revenues jumped by 40% in 2001.
34:51They're not doing anything illegal at all.
34:54It's very clear that they're not breaking any laws that I'm aware of.
34:58I think the debate for people is ethics,
35:01which is a very distinct thing from legality.
35:05As long as there is sort of an untapped market
35:10of patients running around out there who are not on your drug,
35:15you are going to be hiring the smartest marketing people in the world
35:20to figure out a way to convince those people that they have a condition.
35:26They put up all these signs on bus shelters and on billboards,
35:30and there was this phone number on there you could call.
35:33And I remember calling it a few months afterwards,
35:36and you got this recording saying,
35:38this campaign has successfully concluded.
35:40So they kind of wrapped it up pretty quickly
35:43and just said they declared victory and moved on.
35:47Yes, Paxil is a remarkable success story
35:50in how a company has been able to market a product by the,
35:58you could call it creation of a disease.
36:06Most of the time markets are circumstantial, wouldn't you say, with the anxiety?
36:10It's all situational.
36:11These things are all situational depression, situational anxieties,
36:14and they're treated with drugs instead of just trying to counsel
36:17and try to eliminate those factors that are causing it.
36:20It's the easy way out.
36:21Yeah, it's like a crutch.
36:23For the patient and the doctor.
36:24Right, it's the fastest way to overcome.
36:26Everyone's happy, the pharmacist's happy, everyone's happy,
36:30but the patient, is the patient well-served?
36:32I don't think so.
36:33No.
36:34You've got a headache
36:37I've got some strange disease
36:39Don't worry about it
36:41This pill will set your mind at ease
36:44It's called progenitorivox
36:46It's made by Squameroco
36:49It's a life-enhancing miracle
36:51But there are some things you should know
36:54It may cause
36:56Agitation
36:57Palpitations
36:58Excessive salivation
37:00Constipation
37:01Male lactation
37:03Rust-colored urination
37:05Hallucinations
37:06Bad vibrations
37:07Mild electric shock sensations
37:10But it's worth it
37:11For the drugs I need
37:15The thing I've found is they do work, but they make everything very
37:20sort of an even shade of gray.
37:23Funny things aren't as funny.
37:25Sad movies don't give you goosebumps anymore.
37:28Poetry can't make you cry.
37:30I was very disinterested in things I used to be really passionate about.
37:35And even my boyfriend, I wouldn't, you know, it's like, hey.
37:40Like, I don't, I just didn't have that kind of attachment to anything.
37:44I felt really zombie-like.
37:47They wind up placing people on these drugs without, for instance,
37:50any real sense of how difficult it is to get off them,
37:53or what the side effects might be.
37:55And these drugs, you can gain 50 pounds.
37:58You can get diabetes, too.
37:59Like, they're crazy side effects.
38:02They're prescribed almost like candy,
38:05more by primary care doctors, actually, than by psychiatrists.
38:08I always have the impression that patients
38:11believe that psychiatrists are highly knowledgeable
38:15about the neurobiology and the underlying neurotransmitters,
38:19which are the chemicals in the brain that underlie mental illness.
38:23And I think it is surprising when they find out
38:25that we know very, very little about how these drugs work.
38:28They would give you the sample packs and then prescriptions,
38:31and then when you told them how things were working out,
38:33they would recommend a different one and try this one
38:35and try this in combination with this.
38:37Even though it is fun to have someone who, I tell all my friends,
38:40is like Elvis Presley's doctor,
38:42it really isn't a good way to control it.
38:44It feels very artificial.
38:46We didn't discuss cognitive behavioral therapy
38:49or any other kind of talk therapy that might help
38:52or changes in, you know, your diet or exercise that could help.
38:56It was straight to the medication and to a really high dose.
39:00If the only tool you have is a hammer,
39:02then everything you see is going to look like a nail.
39:05And it's the same thing in psychiatry.
39:07If the only tool you have is a drug,
39:09then everything you see is going to look like something
39:11that's a medicatable condition.
39:14Mental health has filled a whole space
39:17that in prior times was occupied by religion, morality,
39:21and by common sense.
39:23I feel there's a tragedy to this.
39:25This is a tragic story.
39:27Social anxiety disorder is an intense fear
39:30of everyday social interactions.
39:32That's really a life-impairing condition.
39:36It's in the newspapers all the time.
39:38It's in the magazines.
39:40It's on the Internet, the television.
39:42Part of the reason anxiety seems to be prevalent
39:44is because it is prevalent,
39:46but another reason is because it's become
39:48part of our vocabulary to talk in psychiatric terms.
39:51Come on up here, Christine.
39:53So we identify ourselves as anxious
39:55in a way that we wouldn't have before.
39:57I've been taking clonazepam lately for anxiety,
40:00little blue pills that look a lot like birth control.
40:03This guy I was seeing thought I was super protected.
40:06I thought, I might get pregnant, but I'll just be cool with it.
40:11It was great. Yeah, it was really fun.
40:14Because it's taking very difficult situations
40:17and making fun of them.
40:19It gave me a really different perspective
40:22and sometimes took the anxiety away from situations
40:24and the fear, because I could just laugh about it.
40:27I ordered a coffee at Starbucks the other day.
40:30I heard, tall, nutty one.
40:32I was offended. They just yelled out my diagnosis.
40:35I don't think there's as much of a stigma as there used to be.
40:39So many people just openly discuss it now,
40:42and they just refer to their therapists
40:45as though they were at their neighbor's house last night.
40:48I was at my therapist's last night.
40:50There's really no odd response,
40:53because they're all in therapy, too.
40:56So we expect anxiety.
40:58Each of us gets the so-called medical student syndrome.
41:01You know what medical student syndrome is?
41:03When a medical student is taking a pathology course
41:06and turning the page and reading about a new disease,
41:09like, let's say, a melanoma,
41:11and all of a sudden as he reads, he looks at his hand,
41:14he says, my God, I've got a mole there.
41:17That could be melanoma.
41:20I'm sure that there's a cultural component, too,
41:23because some cultures don't even have a word for anxiety.
41:26It just doesn't exist in certain cultures.
41:29It certainly exists in ours.
41:32In fact, anxiety has become so much a part
41:35of the cultural discourse,
41:37anti-anxiety pills are now the inspiration for art exhibits.
41:42Does that look great?
41:44Yeah.
41:45I just want to make sure that our placement
41:47is basically how you want it.
41:49Well, they're supposed to look like
41:51they just spilled out of a pill bottle.
41:54We live in the age of anxiety.
41:58There's a correlation between anxiety, in my view,
42:02and advanced capitalism.
42:05The pills that you see are for anxiety and depression,
42:09and the thing that I really want people to do
42:14is to talk about this stuff,
42:17because it's a short-term fix
42:19for a deeper problem in our society.
42:21And I really do think we have to stop it,
42:24and if we just keep medicating ourselves,
42:27we'll just kind of, you know, fall asleep,
42:30and that'll be the end of us.
42:32In the space of a single generation,
42:35anxiety has emerged from the fringe of mental illness
42:39to become completely mainstream.
42:42You need to use both behavioral techniques
42:45as well as medication.
42:47And what are the side effects of the medications?
42:50Sometimes we get aggression,
42:52such as going down to the park and meeting a new animal
42:55instead of being calmer.
42:56The dog's a little more aggressive with other dogs.
42:59So let us know if that happens, but that would be rare.
43:03One of my friends once told me, he said,
43:07Bill, we're living in an uninhabitable culture.
43:11No wonder you don't feel good.
43:13Whether it's any different now than it was through history,
43:17I don't know.
43:19Back in the 18th century, 18th century London, Boswell's London,
43:23believed that they were fast-paced urban life in the Thames,
43:27and they were all just totally stressed out and so forth,
43:30and they made that responsible for their symptoms.
43:32So in a sense, there's nothing new under the sun here,
43:35and the idea that our lives have speeded up particularly
43:38so that now we're more anxious than ever before is just canard.
43:42People have gone through a lot of stuff in this life.
43:46War, famine, pestilence, whatever.
43:49It's like, come on, toughen up.
43:53I think maybe in the former generations that was more of the attitude.
43:57I know they didn't have the medications, weren't as good in those days.
44:01Fresh air and laudanum and prayer.
44:05My mom, her generation, I'm sure, when she was growing up,
44:09wasn't something that you really considered for her,
44:12and it was a lot of, well, you know, walk it off or suck it up
44:16and that sort of stuff.
44:19He's fingernailing.
44:21What has changed over the years, aside from perceptions,
44:25is the way mental illnesses are defined.
44:28I mean, what's outside the human condition that's normal
44:31if all of this is it needs medication or needs therapy or needs treatment?
44:36Okay, so based on what we've all read today,
44:41who has anxiety at this table?
44:43Everyone.
44:46For Stephanie, like so many university students,
44:50it's all about whether or not to medicate.
44:53Is what I'm experiencing, like, is it normal, I guess?
44:58Like, I don't know, is it...
45:00Because I kind of feel like I'm freaking out a little bit more
45:03than most of my friends in my classes are,
45:06or I don't know if they're hiding it better or what's going on.
45:09I would tell you it's fairly normal, what you're experiencing.
45:12Many, many students are experiencing.
45:14It's hard to be at university.
45:16Instead of prescription meds, at least for now,
45:19Stephanie gets a list of lifestyle changes.
45:22No scary movies before bed, warm milk, hot bath,
45:27and doing some breathing exercises regularly.
45:30One of the reasons I kind of go down this path
45:33is that a lot of kids your age think that coming and getting a pill
45:37is going to solve the problem, and it's a temporary solution.
45:40It really doesn't solve some of the lifestyle changes
45:43people need to make to actually make themselves healthier.
45:46There's really some coping strategies that they need to develop
45:49that'll do them really much better in the long run
45:52than to just kind of mask the symptoms.
45:54Does that seem like a reasonable plan?
45:56Yeah, definitely, especially because I don't like medication,
45:59so I'm glad that I have better options.
46:02In some cases, however,
46:04there may be no better option than to medicate.
46:08I get a lot of tension everywhere, like some...
46:12OK, whew, I'm anxious, sorry.
46:15OK.
46:17Also, I'm wondering if I should take a clonazepam.
46:22OK.
46:24I can just express myself a lot better when I take my medication.
46:28You know, everybody's scared to admit they're on them.
46:31For me, it's simple.
46:33I mean, if I had cancer, I would have gone on chemo,
46:36I would have done the radiation,
46:38I would have done what it was my doctor told me to do.
46:42It's what I take to stay well,
46:44and maybe that course of therapy won't always stay the same for me.
46:47Maybe someday that will change, maybe someday I'll come off it.
46:51But in the meantime, I mean, I'm treating myself
46:54for something that makes me unwell,
46:56so I can't beat myself up for it anymore.
47:01I think pharmaceuticals have their place.
47:04I mean, they've saved people's lives.
47:08And I don't think it should be the only route,
47:10and I don't think it should be the first thing
47:12that a therapist pulls out of their toolbox,
47:15and I think that's probably happening a lot.
47:18That's why I choose not to, even though it has been...
47:22It's been recommended sometimes, but it's...
47:26That's my choice.
47:29In most cases, there are other ways to deal with anxiety,
47:32beyond taking a pill, including changes in diet and exercise.
47:38Mindful meditation has made its way into grade schools.
47:42Yoga is a global phenomenon.
47:46So you'll start by just pressing the icon at the top...
47:49There's even an app for anxiety.
47:54To me, anxiety isn't something that you can just sweep under the rug.
47:57You have to deal with it.
47:59And I just have to remind myself to do that.
48:02So I try to take these little steps during the day
48:05where I just say, OK, I'm just going to breathe,
48:07I'm just going to breathe, and I'm going to shut my eyes,
48:10and I'm going to count to five, and then start over.
48:15And that seems to help.
48:18We all have to deal with it.
48:20Everyone has baggage that they have to live with
48:22through their whole life.
48:24Mine had to be anxiety.
48:29But despite our best efforts to tackle anxiety,
48:32as long as psychiatry keeps expanding its domain,
48:36and drug companies go on treating your mental health
48:39like a business opportunity,
48:41we will continue to medicalize the human experience.
48:46The biggest problem with being mislabeled with a mental disorder these days
48:51is that you're very likely to get medication.
48:54And in some instances, the medication may be remarkably harmful.
48:58Bottom line is that the manual of psychiatric diagnosis
49:02should be cautioning against over-diagnosis
49:05rather than encouraging it.
49:09This is just a terrible development.
49:12If you include addictive disorders,
49:14they say three out of four people on a lifetime basis
49:17will have a psychiatric illness.
49:19That's crazy.
49:21It's us. It's the doctors.
49:23Because we're the gatekeepers of the drugs.
49:25We're the ones that write out the prescriptions.
49:27And one of the problems in psychiatry
49:29is that the pendulum has really swung
49:34far too far towards psychopharmacology
49:37or the use of medications.
49:40What we are doing, more or less, is clinicizing human emotions.
49:44So we're taking the experience of being human
49:47and all its complexity
49:49and the way it used to be manifest in song
49:51and in scripture and in theater and in poetry,
49:56and we're turning it into a broken-down piece of biology.
50:26¶¶
50:56¶¶