Chapter 3 (Lecture)

Question 1

Role of medication in recovery process

Answer 1

*different perspectives have come to different conclusions b/c its unclear

• drugs cured depression and addressed a chemical imbalance
• drugs aided recovery process, allowing progress and breakthroughs to be made in therapy
• potential placebo effect: belief it would help was enough to actually help when combined with therapy and lifestyle changes
• combination effect: medication reduced symptoms, enabling more exercise, clearer thinking, and more benefit from therapy

Question 2

what are psychoactive substances?

Answer 2

substances capable of influencing brain systems linked to reward and pleasure, which can alter perception, mood, consciousness and motor skills
- includes psycho-pharmacuetical medications as well as both legal and illegal drugs

Question 3

alcohols dual role

Answer 3

commodity and drug

• alcohol-based c commodities are bought and sold in marketplaces (economic function), it is an industry itself and central to other industries (hospitality, tourism), and the industry uses complex marketing techniques to cultivate new consumers and markets

Question 4

alcohol is a psychoactive substance with toxic effects

Answer 4

consumption produces intoxication and continued use may lead to dependence

• negative health and social consequences

Question 5

How is alcohol an extraordinary commodity?

Answer 5

as a commodity that produces health risk and harms it should be regulated, but that is unpopular and the alcohol industry actively campaigns against stronger regulations and public health measures that would restrict access and reduce consumption

Question 6

Pre-history of psychopharmaceuticals (alcohol)

Answer 6

• previously prescribed as medicine and used informally for therapeutic purposes - in addition to extensive recreational, spiritual, and cultural use
• alcohol prohibition driven by concerns about health and social harms but not solely a medical problem, but a social one (w moral dimensions) focused on harms to individuals, families and communities

Question 7

morphine and cocaine

Answer 7

morphine: sold and marketed to relieve pain and nervous irritation, quiet restlessness, promote sleep
cocaine: sold and marketed as brain “tonic” and stimulant

• morphine and cocaine were exclusively produced by pharmaceutical industry, almost always advertised as therapeutic
• some companies were more “ethical” - targeted only physicians, used tested ingredients and noted contents of products
• “patent” medicines (brand name products) sector of the market: secret ingredients, trying new substances, advertised extensively directly to consumers

Question 8

shifts to increased regulation of psychoactive substances

Answer 8

• unregulated sales led to an epidemic of opiate and cocaine use
• reformers advocated for control and regulations to manage the distributions of drugs, reduce consumption and health/social problems
• accomplished through the licensing and regulation of physicians and restricting the legal treatment of illness to physicians
• regulation of pharmaceutical companies

Question 9

3 main ways they increased medical regulation of substances

Answer 9

1. raising educational and licensing standards for physicians
2. creating legal monopoly on treatment of illness for physicians
   (monopoly - the exclusive possession or control of the supply of or trade in a commodity or service)
3. regulations for the pharmaceutical industry

Question 10

Acts implemented to regulate psychoactive drugs - what is the immediate impact and implications?

Answer 10

immediate impact: reduced physicians prescribing of psychoactive drugs, “non-medical” sales became illegal and criminalized

implications: access to psychoactive drugs became officially managed by physicians and medical industry - substances were now fully medicalised

Question 11

When did psychoactive drugs became conceptualised?

Answer 11

following WW2

Question 12

What is Miltown?

Answer 12

minor tranquilliser specific effect on anxiety rather than being a general sedative - claimed to treat anxiety without the risks of barbiturate medications

• overshadowed antipsychotics and antidepressants

lessons: benefits overstated, risks/side effects harms understated, extensive sales and profits, large consumer demand

Question 13

what were the important changes to psychiatry in the 50s and 60s?

Answer 13

• shifts from institution to community: partially due to use of thorazine and antidepressants to reduce severe symptoms, even seriously ill individuals could be cared for outside hospital
• increasing predominance and adoption of the biological model among some psychiatrists: effectiveness of medications encouraged support for neurochemical basis of mental illness, BUT psychodynamic (and freudian) beliefs continued (emphasis on psychotherapy)
• marketing depicted medications as an adjunct for physicians: to help patients make progress in psychotherapy, not an inherent cure

Question 14

Biological psychiatrists perspective on mental health

Answer 14

believed that mental illness was primarily (or entirely) a biological phenomenon, rooted in dysfunction of the brain

Question 15

two theories from biological psychiatry that were shaped by the effects on management of symptoms

Answer 15

1. emerging antipsychotics (used to be called major tranquillisers) altered dopamine function, led to conclusion that schizophrenia must stem from inherent dopamine problems in the brain
2. SSRI antidepressants appeared to correct serotonin imbalances, leading to theories emphasising neurotransmitters based causes of depression
   - some argue that “chemical imbalance” explanations are more of a marketing tool than coherent explanation of the causes of mental illness

Question 16

Kefauver Harris Amendment to the Federal Food, Drug, and Cosmetic Act

Answer 16

requires companies to demonstrate not just safety, but that they are effective

• not more effective than existing or competing medications, just more effective than a placebo

Question 17

What’s one reason why more people were getting prescribed medicine?

Answer 17

Because health system pressure on physicians to treat more patients in shorter amounts of time led to higher rates of prescribing as a response to mental illness

Question 18

What is disease mongering?

Answer 18

(Introduced by psychiatrist David Healy in 1997): a marketing strategy increasingly shifting away from selling specific medications toward marketing the idea of particular diseases to consumers

• selling disease to grow patient population and develop markets, maximising perceived prevalence and severity of mental illness by subtly redefining who was deemed to have psychiatric symptoms
• some critics point to this as the medicalisation of normal human experience and the range of experiences and emotions

Example: FDA approved Xanax for social anxiety disorder, thus transforming shyness into a “disorder”

Question 19

Percentages of modern use of psychiatric drugs

Answer 19

2005-2008:
- 11% of Americans filled a prescription for a daily antidepressant
- 7% received a monthly antidepressant prescription for 2 or more years
- Approx 14% taking antidepressants, have been taking them for 10 years or more

antidepressant use increased 400% in the US between 1988-2008

Women are more than twice as likely as men to use psychiatric drugs

Question 20

Naming and Classifying drugs

Answer 20

All drugs have a chemical name, generic name, and a trade name

example: sertraline (generic name), zoloft (trade name)

Trade name: intentionally selected to describe the medication or effect (Effexor - effect, effectiveness. Abilify - able, ability)

Drugs can be classified by:
- diagnostic symptoms they target
- chemical structure of the medication
- neuro-receptors, action and mechanism

Question 21

What are the 4 families of medications?

Answer 21

1. antidepressants (prozac, zoloft)
2. anti-anxiety agents/anxiolytics (prozac, Effexor)
3. antipsychotics (risperdal, Abilify)
4. mood stabilisers (lithium, Seroquel)

Question 22

Feminism and the Valium Panic

Answer 22

• increasing numbers of American women experienced overdose episodes and dependence related to Valium
• Feminists argued that Valium was being prescribed to women for conditions that are social problems - fatigue, nervousness, anxiety (which stems from gender roles) rather than mental illness
• These concerns led to changes in the regulation and marketing of Valium