In response to:

Talking Back to Prozac from the December 6, 2007 issue

To the Editors:

In his description of the relationship between pharmaceutical companies and the mental health industry [“Talking Back to Prozac,” NYR, December 6, 2007], Frederick C. Crews characterizes condition branding as an effort by pharmaceutical companies to persuade “the masses…that…one of their usual…states actually partakes of a disorder requiring medication,” implying that condition branding is an effort by “Big Pharma” to convince potential patients of their own illness. In doing so, he neglects to address condition branding’s secondary message: not only are its audience’s own personal dissatisfactions medically treatable, but their relatives’, friends’, and neighbors’ behaviors are also controllable by medication. While “self-reporting is the only means by which nonpsychotic mental ailments come to notice,” the decision to self-report isn’t a self-contained process within the patient, and Big Pharma markets accordingly.

Minor children, and preschoolers specifically, have been identified as the largest growing market for antidepressants (“Trends in the Use of Antidepressants in a National Sample of Commercially Insured Pediatric Patients, 1998 to 2002,” Psychiatric Services, April 2004). The greatest recent growth in psychopharmaceutical consumption, ipso facto the greatest growth in psychopharmaceutical consumption in the era of condition branding, is occurring in a population that can hardly be described as self-diagnosing. Clearly the infamous “nag factor,” where advertisers market to children in the hope that they will then persuade their parents to purchase, doesn’t apply to Prozac; rather, the message of condition branding is reaching its intended targets (adults) and inspiring them to see newly diagnosable, newly treatable symptoms not in themselves but in those around them.

The tendency to identify psychological illness in others is not limited to minors and it is not an unintended side effect of condition branding aimed directly at the end user. The Roche Pharmaceuticals Web site for its Accu-Chek diabetes product contains a section for “caregivers,” counseling them that if their diabetic loved one is “feeling sad or irritable” or experiencing any other of a laundry list of general symptoms, they “may have depression.” Using the same techniques described in Crews’s article, the Web site brands depression not as something its audience should be concerned about in themselves, but as something they should look for in others, with or without their agreement. “Your spouse may feel it’s hopeless to reach out for help. Your spouse is wrong” (, the antidepressant manufacturer enjoins the public, encouraging readers to pursue treatment for their loved ones even if faced with spouses who are less than enthusiastic about the diagnosis.

An understanding of condition branding’s secondary aspect does not change the interpretation of Big Pharma’s goals in its employment—through direct or once removed means, its intention is to increase the number of consumers of its products and thereby increase its profit. If “episodic sadness” has, as Crews relates, truly changed from “socially approved means of adjusting to misfortune” to something society defines as a disease, Big Pharma has not effected the change through force or decree. Rather it has persuaded society to shift its views, and it has done so by exploiting a preexistent human desire.

Certainly, one desire it underlines is the desire to believe our flaws are not our fault and that we can fight them through self-diagnosis. However, as much as Ricky Williams’s appearance on The Oprah Winfrey Show promotes the conclusion that if a star football player suffers from “shyness,” so could any of us, for a viewer seeing a difference between him/herself and a Heisman winner the message might as easily be: if he suffers from “shyness,” so could any of them.

Andrew Branch

Portland, Oregon

This Issue

May 1, 2008