SELLING MADNESS: PSYCHOPHARMACEUTICAL
COMPANIES IN LITHUANIA,
1990-2000
Let us ever hold fast to
what it is to be a human being. Soren
Kierkegaard Only science, exact
science about the human self, and the most
sincere approach to it by the aid of the
omnipotent scientific method, will deliver man
from his present gloom, and will purge him from
his contemporary shame in the sphere of
inter-human relations. Ivan Petrovich Pavlov
INTRODUCTION
The breakup of the Soviet Union has
created enormous tensions, both economic and
cultural, for its former member states. Once
under the watchful and guiding eye of the Soviet
Union, the former republics suddenly had to
determine how to react to an increasingly
integrated global economy. Lithuania, since its
reestablishment of independence in 1991, has
been torn between the legacy of Communist
influence from the East, and cultural and
economic pressures from the West. As I will
show, Western influences have led to major
changes in Lithuanian mental health. Lithuania
has experienced a sharp increase in certain
types of mental illness between 1997 and 1998,
as indicated in Table 1.*
TABLE
1. Rates per 100,000 of Specific
Mental Disorders and % Change
Disorder
ICD-10 Code
1997
1998
% Change
Organic, including symptomatic mental
disorders.
F00-F09
23.8
45.5
+91.2%
Schizophrenia.
F20-F29
23.8
27.5
+15.6%
Mood (Affective) disorders.
F30-F39
25.1
101.6
+305.0%
Neurotic and Stress-related
disorders.
F40-F49
16.1
24.3
+50.9%
Behavioural syndromes associated with
physiological disturbances and physical
factors.
F50-F59
0.6
1.8
+200.0%
Disorders of adult personality and
behaviour.
F60-F69
8.2
9.3
+13.4%
Source: Lithuanian Ministry of
Health.
*Having gathered this data
during the Summer of 2000, I was unable to
expand upon this two-year period, since I am
unable to find this information in the United
States. According to information provided by the
Vilnius Psychiatric Clinic,
http://www.sam.lt/statistics/tablel4.htm,
incidence of affective mood disorder in the
mental health system increased from 25.1 to
101.6 per 100,000 people between 1997 and
1998.
The question driving this
research is why rates of mental illness in
Lithuania have increased so rapidly in the 1990s
in light of the rising influence of Western
pharmaceutical companies. These firms expanded
their marketing strategies in Lithuania, since
it became an untapped market after the fall of
the Soviet Union. Using both formal and informal
means, the pharmaceutical industry influences
the diagnosis of various types of mental illness
treated by medications sold by these same
pharmaceutical companies.
While other scholars have
stressed the role of the interaction process
between individuals, this research contributes
to the debate of the social construction of
mental illness by emphasizing the macroeconomic
sources of the diagnosis of mental illness.
The Social
Construction of Mental Illness
This section provides a
brief overview of three general perspectives on
mental illness, and indicates ways in which this
paper fits within and contributes to these
established paradigms. My argument for a
relationship between increasing rates of mental
illness and the expanding market of foreign
pharmaceutical companies draws upon labeling
theory and the antipsychiatric school of
thought.
Labeling theory is based on one
fundamental idea: those who are labeled deviant
and treated as such will become deviant (Scheff
1974, Lemert 1951, Lemert 1972, Becker 1973). By
extension, those who are treated as mentally ill
will come to act mentally ill, thereby beginning
a self-perpetuating cycle. For labeling
theorists, mental illness does not exist in the
sense proposed by those who embrace a medical
(or "biological") model, which sees mental
illness as a physiological phenomenon that
should be treated like any other disease. Mental
illness is fundamentally a social phenomenon for
labeling theorists and for those who refer to
the "medi-calization" of mental illness. Both
see mental "health" as being an arbitrary
condition (Conrad 1975, Szasz 1963, Scull 1975,
Laing 1967, Goffman 1959). Behavior becomes
socially constructed, as proposed in the
"radical" perspective of the antipsychiatrists
(so-called due to their opposition to the
medical model), using the legitimacy of the
medical institution as an agent of social
control (Conrad 1980, Szasz 1963). Psychiatrists
such as Laing (1967,1969) and Szasz (1974), who
argue that mental illness does not exist at all,
represent the extreme fringe of the
antipsychiatric model. While Laing sees
schizophrenia as a "sane reaction to an insane
world," Szasz sees mental illness as a medical
"myth," because there are no signs of physical
lesions. What is missing from this perspective
is a macro-level analysis that emphasizes
economic factors.
The above-mentioned
researchers focus on a micro context. My
research contributes to their paradigms by
proposing that mental illness is intimately tied
to large economic processes. I examine how the
social construction of mental health at the
micro level is shaped by macroeconomic
conditions, specifically, the rise of capitalist
drug companies in Lithuania in the context of an
increasingly integrated capitalist world
economy.
THEORY
I hypothesize that Western
pharmaceutical companies seeking new markets for
their medications are in effect creating a
demand for their products, which, in turn, leads
to increasing rates of diagnosed mental illness.
Theoretically, my project contributes to the
field of social psychiatry by linking
psychiatric diagnoses to economic changes. Also,
the issue of what underlies mental health
sociologically has practical implications, both
in Lithuania and the United States, for at least
two reasons. First, how mental health is defined
sets the stage for research agendas and policy
issues. For example, if mental illness is deemed
a mainly physiological phenomenon, as was the
case in the Soviet Union, then biological
treatment makes sense. Yet if mental illness is
seen as having both social and biological
causes, then a blend of treatments, both social
and physiological may be useful. Second, how
mental illness is defined also impacts the way
mental patients view themselves, which, in turn,
influences their coping strategies (Townsend
1975, Karp 1996). Third, how psychiatrists view
and treat mental patients is related to
determining the cause of their
afflictions.
This study not only
contributes to sociological literature on
Lithuania and Eastern Europe, but is relevant to
psychiatric processes in the United States and
other capitalist countries as well. As the
markets that psychiatry comes to dominate
expand, consumers and society as a whole must
become increasingly aware of the possible
dangers in this domination. Sociologists must be
aware of and investigate the social nature of
mental illness and the relationship between the
legitimacy of the medical model and economic and
cultural factors supporting that
legitimacy. Figure 1 models the hypothesized
relationship between capitalist development and
increasing rates of mental illness. Drawing on
world-systemic explanations of a global
capitalist economy (Chase-Dunn 1982; Chase-Dunn
and Boswell 1998), I argue that Western capital
influences the operation of pharmaceutical
companies. These firms, which must operate
profitably, do so by marketing their products
aggressively. Western pharmaceutical companies
entice Lithuanian psychiatrists to prescribe
more pharmaceuticals, which increases both the
profits of the pharmaceutical companies and the
official rate of mental illness.
Figure 2 diagrams a more
elaborate model that illustrates the
relationship between the discussed variables. It
indicates that there is a complex
interrelationship between several important
factors. The state is interested in saving money
in its health care system, and, therefore,
minimizes the use of expensive treatments, such
as traditional "talking" psychotherapy. Drug
companies seek to maximize their profits. Both
the state and the drug companies influence the
psychiatrists who deal with clients/patients.
Though psychiatrists determine the diagnosis,
patients may come to them already seeking
medication.
Lithuania is a fruitful
choice for studying the effects of capitalist
development on rates of mental illness, because
it has experienced a sharp rise in the influence
of capitalism during the past ten years. One
would expect the reforms in psychiatry enacted
in Lithuania to increasingly resemble those
observed in a capitalist system. This study is a
timely one. The breakdown of the Soviet Union in
1990 has led to a major transformation in
formerly socialist societies. The breakup of the
Soviet Union has created new markets for foreign
investors eager to sell products and services to
people used to living under communism.
Lithuania's
Post-Socialist Economy and Capitalist Influences
on Mental Illness
Following the collapse of
the Soviet Union, Lithuania's economy converted
from the socialist command economy to a
capitalist-oriented market economy. There is
much discussion within social and economic
theory describing the Eastern European economic
transition. Szelenyi (1998) built upon the work
of Polanyi (1951) in seeing distinct stages in
the transition from state socialism to the
development of a market economy with capitalist
institutions. The key factor, Szelenyi argues,
is the role of business in consciously creating
and expanding capitalist markets in Eastern
Europe. My research draws from Szelenyi's
argument by indicating the role of drug
companies with the help of psychiatrists in
consciously expanding their markets. Health
is related to the economic transition. Brainerd
(1999) indicates that there is a relationship
between the market reform of Eastern and Central
European nations and mortality rates in those
countries. Although the money that the Baltic
Republics can spend on health and social
services is mediated by many social and economic
factors, the amount spent is related to the
government's annual revenue.
My research
suggests that, when faced with difficult
economic choices, the Lithuanian government
seeks to address the health care needs of the
population (e.g., a very high suicide rate) with
the most cost-effective means possible
(medication, as opposed to psychotherapy).
In this section, I will
review different perspectives on the
relationship between psychiatry and capitalism.
Unlike a capitalist economic system, the
Soviet-style command economy fostered no profit
motivation for markets to expand.
Under
capitalism, psychiatry operates on a for-profit
basis. One implication of this is unequal access
to quality treatment. For example, Garfield
(1994) indicates that the upper classes receive
far better psychiatric care than the lower
classes in the United States. He suggests that
the treatment given to the upper classes is
based on insight and inner understanding, while
that given to lower socioeconomic groups is
based on chemical pacification and containment.
This type of care is by far much more expensive
than simply medicating a patient, which appears
to be the more common practice in
Lithuania.
Bryan Turner (1995) points to
the increasing globalization of Western medical
knowledge. He discusses medical knowledge in
theory, but does not address the complex
interplay between professional psychiatric
organizations and capitalism. According to U'ren
(1997) both capitalism and psychiatry are
interested in expanding their markets. U'ren
draws upon Marxist conceptions of economics in
capitalism, using Marx and Engels' (1848/1948)
notions of capitalist competition, where
capitalists create a "market" for the
psychopharmaceutical industry. Using the Marxist
M1-C-M2 formula, an initial investment (M1)
leads to a commodification (C), which is then
sold for profit (M2). This profit is then
reinvested for more profit as the cycle
continues. In short, in order to create a
profit, goods must be marketed.
Foucault (1965) also saw
socioeconomic factors as influencing the
conception of, and creation of, mental illness.
He argues that as the industrial revolution
brought new era thought about the mentally ill,
the rhetoric used to discuss the mentally ill
changed: the "village idiot" began to be
identified as a patient. Foucault finds no
surprise that the industrial revolution brought
with it the first asylums for the mentally
handicapped, as the need for increasingly
reliable labor became important. Although
Foucault focuses on the relationship between
discourse and economic factors, he sees the
economy as a unit, rather than a set of
competing interests that seek profit through
labeling some as mentally ill. While U'ren sees
psychiatry as operating along with the
capitalist economic system, Foucault sees
demeaning language as being an indirect cause of
the changing economic systems. In contrast to
Foucault, who emphasizes the capitalists'
interest in maintaining a steady supply of
reliable labor, I focus on the need to expand
drug markets, which encourages the labeling of
people as mentally ill.
Though my research draws
upon aspects of all the mentioned theorists, it
most closely resembles the claims made by U'ren.
However, while U'ren focuses on diagnostic
criteria, I see psychiatrists as the middlemen
between larger capitalist economic forces and
the official rates of psychiatric disorder they
create. What is missing from U'ren's discussion
is the way that psychiatry expands its markets
and the role drug companies play in this
expansion.
My research further indicates
that mental illness is created through economic
processes. Various researchers see the major
diagnostic tool used by American psychiatrists,
the Diagnostic and Statistical Manual, as
creating mental illness through its use of
categories, labeling the afflicted, and treating
behavior as signs of mental illness (Sands,
1983; Mi-rowsky, 1989).
Methods
Three primary sources of data will be
utilized to support my argument: interviews with
various individuals associated with the mental
health care system, government statistics, and
archival data. Most of the archival materials
consist of Lithuanian news articles from the
Mazvydas Library and the Vilnius Medical
Library.
This extended case study
focuses on developments in Lithuanian psychiatry
in the period from 1990 to 2000. 1990 is the
year Lithuania first began to take clear steps
towards independence on the world stage. Through
interviews, I was able to see the world thorough
the eyes of Lithuanian psychiatrists. Those
interviewed were found by using the "snowball"
approach. From a personal contact in Los
Angeles, who had finished medical school in
Vilnius, I was able to interview her former
professor, who is now the current dean of the
University of Vilnius medical school. This
contact, in turn, led me to other psychiatrists
in Lithuania, and so on.
Some of those interviewed,
such as the dean of the Vilnius medical school,
offered perspectives from a position of power
within the health care system. Another
psychiatrist interviewed was the director of a
state-run clinic, while others were former
presidents of the Lithuanian Psychiatric
Association. Lastly, some psychiatrists were
physicians employed by various state-operated
clinics, which constitute the bulk of
psychiatric clinics in Lithuania.
Interviews were conducted
in an unstructured format, and all conversations
took place in the Lithuanian language. Five
individuals were interviewed during the summer
of 2000: four psychiatrists and a Baltic
representative for the pharmaceutical company
Eli Lilly. Open-ended questions were asked;
interviews typically lasted from one hour to an
hour and a half. Three general topics were
discussed in interviews: the respondents'
accounts of the economic transition to
capitalism, the role of medication versus
psychotherapy, and Western pharmaceutical
companies' influence on psychiatry in
Lithuania.
The government statistics
used to support my conclusions were obtained
from the Lithuanian Ministry of Statistics and,
in the case of diagnoses of specific types of
mental illnesses, from the Vilnius Psychiatric
Clinic. Archival data were used for general
background information on changes in government
policy on mental health and public perceptions
of mental
illness.
FINDINGS
This section is organized around several
dominant themes appearing in the data. First,
recent trends in Lithuanian mental health care
will be discussed, in addition to current rates
of mental illness. As will be indicated, the
government's need to save money, the prior
dominance of the medical model under Soviet
rule, and the perception of suicide as a public
health problem have all had an impact on rates
of mental illness. Next, an argument is
presented about the means by which
pharmaceutical companies influence rates of
diagnosis of mental
illness.
Recent Trends in
Lithuania's Mental Health
Since re-independence, Lithuania's
Ministry of Health began to gather its own
health statistics. Table 1 indicates the total
number of reported cases of mental disorders in
the records of the Ministry of Health for the
years 1997 and 1998 for all types of mental
illness. As is evident, the rates of increase
are highup to 305% for affective mood
disordersEfrom 1997 to 1998. How can such rapid
increase be explained?
The
"Courting" of Lithuanian
Psychiatrists
Drug companies in Lithuania
use aggressive marketing techniques. The
conference Depresija 1995 (Depression 1995) was
sponsored exclusively by Eli Lilly, and the 2000
National Suicide Conference was cosponsored by
Eli Lilly. These conferences served several
purposes. According to an Eli Lilly
representative, "Doctors came and learned about
depression and its treatment." Psychiatrists
indicated that drug companies actively encourage
doctors to attend conferences through informal
enticements. The dean of the medical school told
me:
They sent doctors to conferences. The
firms organized these conferences. Sometimes
they were close to ballets. The doctors that
went were made to feel good, so that they would
want to go. There is a turn to bio-psychology,
away from psychotherapy.
When asked about
the Depresija 95 conference, a psychiatrist came
to a similar conclusion: Eli Lilly organized
it. It was in Kaunas [The second largest city in
Lithuania]. It was the debut of Prozac [in
Lithuania]. The Prague theater was there. The
pharmaceutical industry invited doctors. It was
like a big party, a big deal.
Though such perks are
common to medical conferences in the Unites
States, one must remember the cultural and
temporal context in which this "courting" is
taking place. During the Soviet era, Lithuanian
medical doctors were (and continue to be) paid
very little relative to their Western
counterparts. According to government
statistics, in 1997, the average worker in
Lithuania earned 785 litas (approximately 196
USD) per month, whereas those engaged in human
health activities earned only 640 litas
(approximately 160 USD) per month. In 1997,
doctors and other medical personnel earned, on
average, the same amount per month as those
engaged in sewage and refuse disposal
(Statistical Yearbook of Lithuania,
1999).
Psychiatrists in Lithuania enjoy
going to corporate-sponsored conferences very
much. For them it is a taste, perhaps the only
taste, of the "good life." As Western culture
becomes increasingly visible in Lithuania,
doctors would be expected to desire the cultural
and material rewards associated with the medical
profession in the West. The amount drug
companies spend on conferences is only a
fraction of the amount earned from the potential
sales of pharmaceuticals.
When asked if drug
companies can find out if particular doctors use
certain products, a psychiatrist responded,
"Yes. It's all in the books." Thus, informally,
drug companies are able to "reward" doctors that
prescribe their drugs through conference
invitations. It seems that drug companies are
"enticing" psychiatrists to prescribe
medications, which is, in turn, reflected in the
increasing diagnoses of mental
illness.
Lithuania's
High Suicide Rate as a Public Health
Problem
A second
explanation of why drug companies have been able
to market their products so easily in Lithuania
revolves around the high incidence of suicide in
the country. Before the Soviet occupation,
Lithuania's suicide rate was among the lowest in
the world. However, as Table 2 shows, the rate
steadily increased during the Soviet era and is
now among the world's highest. Table 3 shows
Lithuania's suicide rate compared to several
other nations.
TABLE 2.
Total Number and Rate of
Suicides in Lithuania.
Year
Total
Rate per 100,000
1990
969
26.0
1991
1142
30.5
1992
1294
34.6
1993
1572
42.1
1994
1703
45.8
1995
1694
45.6
1996
1723
46.4
1997
1632
44.0
1998
1554
42.0
Source: Lithuanian Ministry
of Health. Various explanations have been
offered for this high rate. One supposes that
the rapid pace of social and economic change in
Lithuania, following its independence has caused
an increase in anomie. Another reasons that it
is related to Lithuania's high rate of per
capita alcohol consumption, which historically
has been roughly proportional to rates of
suicide. As shown, compared to other nations,
even those close by, such as Estonia,
Lithuania's suicide rate is very
high.
TABLE
3. Suicide rate per 100,000 for
Selected Countries.
Country
1990
1995
1998
Lithuania
26.1
45.6
42.0
Estonia
27.1
40.1
33.2
Hungary
39.9
32.9
32.1
USA
12.4
11.9
11.4
(1997)
Spain
7.5
8.1
8.5
(1996)
Source: World Health
Organization.
The growing perception of
suicide as a major public health problem in
Lithuania is important for this research because
suicide is linked to various diagnoses of mental
illness, such as depression. Partly in reaction
to the high rate of suicide, a conference on
depression was sponsored in 1995 in the city of
Kaunas. Furthermore, a national conference on
suicide prevention took place in Lithuania in
2000. From the Lithuanian government's point of
view, such a high suicide rate provides a
mandate to seek cost-effective strategies such
as drug-based therapies, aimed at reducing
suicide.
Changes in
Health Care Structure
Since effective
psychotherapy is potentially longer and more
expensive than drug therapy, the latter is
favored by the government. As one psychiatrist
said,
...there was mandatory health
insurance. This had the effect of medicalizing
the medical system. Medicine is medicaldrugE
treatment, so there can be no psychotherapy.
Changes in health care
reform favorably influenced pharmaceutical
companies' ability to sell their products. Prior
to 1994, there was no national health insurance
in Lithuania. According to the first president
of the Lithuanian Psychiatric Association, since
the passage of a 1995 law, which promises all
employed Lithuanians health coverage, there has
been a movement toward greater
biological-medical treatment of mental health.
As Polubinskaya (2000) points out, there was a
movement among psychiatrists in Lithuania to
make a conscious break with the past. The dean
of the Vilnius medical school explains,
I was the first head [of
the Lithuanian Psychiatric Association]. They
wanted the young [doctors] to get involved.
There's the problem of stigma; during Soviet
times, the mentally ill were locked up, now they
are deinstitutionalized. Society feels they
should be locked away. The "Sajudis"
political movement, which sought independence
during Soviet rule and whose proponents
ultimately came to power in the newly democratic
Lithuania, wanted progressive psychiatrists,
such as the current dean of the medical school,
to steer Lithuania's practitioners away from
Soviet-style therapy. To illustrate his reformed
practice, the dean placed a renewed emphasis on
psychotherapy and other forms of social and
nonbiological therapy in Lithuania.
The shift from
psychotherapy to drugs is related to a shift in
government agencies, such as the Ministry of
Health, toward private, rather than governmental
sources of funding. Also, embarking toward
deinstitutionalization of the mentally ill, the
government is shifting to medicines that deal
with the most severe cases ("ambulatory"
medicine), as indicated by the reduction in the
number of psychiatric hospital beds. Through
medication, physical restraints have been
replaced by chemical ones. Drugs used by
Lithuanian doctors to treat affective mood
disorders are now prescribed more often,
reflecting the increase in diagnosed
disorders.
Influence of the
Biomedical Model Under Soviet Rule
The biological model that dominated
Soviet medicine viewed psychiatric disorders as
resulting from a breakdown in the organism
itself (Krethschmer, 1978). According to Marxist
dialectical materialism, which was the
philosophical basis of Soviet ideology, in the
Utopian workers' society (which the Soviet Union
claimed to be), there could be no social cause
for mental illness, hence the ideological search
for biological causes of illness. A biological
breakdown in psychological functioning was
treated with biological means, as Miller (1985)
clarifies:
Even before the 1917
revolution, psychiatric theory in Russia,
dominated by Kosakov and also by the work of
Vladimir Bekhterev in neurophysiology, was
oriented around the notion that most mental
disorders were based on functional changes in
cerebral activity or brain injuries of various
kinds (p.15).
The Soviets rejected
Western models of psychology, such as the
Freudian, because they did not deny the
influence of external factors on mental health
(Miller, 1985). As a result, Soviet psychiatry
stressed the role of biological and chemical
forms of treatment (Wortis, 1950). This
biomedical approach has established societies
that see the role of medication differently than
do Western societies.
Professional
associations in Lithuania and other post-Soviet
countries are seeking new approaches to
treatment. For example, Polubinskaya (2000)
affirms the intention of the Lithuanian
Psychiatric Association to "develop diagnostic
and therapeutical [sic] approaches other than
biological psychiatry." Polubinskaya's work
relates to my research by indicating the legacy
of the biomedical model in Lithuania and the
LPA's attempt to move away from biological
psychiatry.
This Soviet predisposition
to see mental illness as something to be treated
biologically, further enabled the drug companies
to market their products to the medical
community. In elaboration of this view, a
Lithuanian psychiatrist told me:
The government seeks to
augment the role of the biological model in
preventing suicide. It is funding suicide
prevention in the form of antidepressants.
The psychiatrist's
reference to the "government" includes agencies
responsible for health care, but especially the
Mi-nistry of Health.
Recent Changes
in Psycho-pharmacology and Psychiatry in
Lithuania
It seems clear that the
stage was set for drug companies to enter
Lithuania around the middle of the 1990s.
According to a Baltic representative for a
Western pharmaceutical company, following the
disintegration of the Soviet Union, many
corporations began conducting business in the
newly independent Baltic States to meet a need
for insulin. In 1994, Eli Lilly opened an office
in Vilnius and began to market its products. The
expansion of drug companies into Lithuania had
an impact on psychiatry as well. The number
of psychiatrists in Lithuania has been
relatively stable, perhaps due to informal
benefits, while the numbers of other specialists
are in decline, as Table 4 indicates, following
the strategy employed by the Lithuanian health
Program (http://www.sam.lt), a long-term goal of
the Lithuanian Ministry of Health is to increase
the number of psychiatrists from 230 to 250 by
2005. Table 4 indicates the changes in the
number of various types of health care
professionals in Lithuania.
Table
4.
Number of Lithuanian
Physicians by Specialties and Year.
1985
1990
1995
1996
1997
1998
Specialty (Area and %
Change) 1985-1998
418
552
543
531
530
503
Neurology (+16.9%)
445
497
512
505
527
519
Psychiatry (+14.3%)
1716
1960
1699
1666
1646
1583
Pediatrics (-8.4%)
1693
1521
1371
1352
1340
1229
Surgery (-27.4%)
364
287
255
253
243
229
Pulmonary disease
(-59.0%)
Source: Lithuanian Ministry of
Health. As a whole, after reaching a high
point in 1990the year prior to Lithuania's
Independencethe number of physicians in
Lithuania has steadily decreased. This can be
explained by a number of factors, including a
changing demographic structure in Lithuania.
Table 5 shows the decreasing number of 20 to 24
year-olds, roughly the age group that would be
entering college or medical
school. Table
5.
Lithuanians Aged 20-24 During
Selected Years, in Thousands.
Year
1985
1990
1995
1999
Number
297
276.9
283.7
259.8
Source: Lithuanian Ministry of
Health.
Due to this demographic
shift, fewer students will finish medical school
and go to work as doctors, or enter medical
school at all. The relevant conclusion of Table
4 is that, while the number of specialists in
various fields are decreasing, psychiatry is one
of the few specialties that seems to be
maintaining its numbers. One explanation for
this is the desire for doctors to enter a field
fostered by the government. Despite a decrease
in 20 to 24 year-olds, there has been no
decrease in the number of psychiatrists. Yet
another explanation is the role of well-paying
foreign drug companies vying for medical school
graduates. As the medical school dean indicates,
there are competing interests for those that
potentially may be entering psychiatry, "Doctors
that graduate here [from Vilnius Medical School]
and work for drug companies earn five times as
much as [those] working at a hospitalit is a
dream for them." Another interesting
conclusion relates to the surprisingly small
number of physicians entering cardiovascular
medicine. According to the Ministry of Health,
heart disease accounts for approximately one
half of total mortality. Given this high rate,
one would imagine the number of physicians
entering the field to dramatically increase, not
decrease.
The expected rise in Lithuanian
psychiatric specialists would lead one to
predict a further rise in affective mood
disorders in the near future. With more
psychiatrists entering the health care system,
one would predict that there will be an overall
increase in diagnoses. In the coming years, with
predicted increases in the number of
psychiatrists, a continued increase in the
diagnosis of mental illness would not be
surprising.
CONCLUSION
In summary, my research
reveals the connection between economic factors
and the increasing diagnosis of depression in
Lithuania. The primary reason for the increase
in diagnoses of depression is the influence of
Western drug companies, which have managed to
sell their products in Lithuania for three
reasons: the government's need to save money,
the prior dominance of the medical model, and
the perception of suicide as a major public
health problem.
Three general conclusions
can be drawn from this research. First, the
relationship between drug companies and the
Ministry of Health is called into question. In
young democracies, such as those in the former
Soviet republics, business and social welfare
must remain distinct. Second, increasing
medicalization allows more power to fall into
the hands of the medical professionals, who, as
was indicated, are closely tied to market
forces. As this research indicates, mental
illness is a label which is all too easily
applied. When individuals are led to believe
that they are sick, their entire lives are
affected. A third implication of this research
relates to the consequences of medicating a
population for the sake of profit. Anyone who
has noted the side effects listed for common
psychoactive drugs sees that often the
physiological effects, such as sexual problems,
tremor and in the case of Zoloft, feeling
unusually sleepy, may be just as serious as the
symptoms the drug was taken to
relieve.
Lithuania is an ideal market for
pharmaceutical companies. Of course, there may
be a positive aspect to the presence of drug
companies in Lithuania: Sick people are treated
with quality medicine. Nonetheless,
medicalization can be abused, and patients who
could be treated through talking forms of
psychotherapy may be overmedicated to their
detriment.
My research contributes to the
field of social psychiatry by linking capitalist
economic influences to the rates of mental
health diagnosis. Under capitalism,
psychopharmaceutical companies operate for a
profit. In order for drug companies to realize a
profit, they must make sure that patients are
diagnosed with mental illnesses treatable by
psychotropic drugs. Mental health, therefore, is
an arbitrary condition closely tied to economic
factors: under capitalism, where profit is
paramount, diseases, such as anxiety disorders,
are marketed to their fullest extent by drug
companies and psychiatrists.
My research indicates a
connection between capitalism and the increasing
diagnosis of mental illness in Lithuania. We are
forced to consider the role of the economy in
creating disorders and illnesses from thin air.
Medicine, as a profession, rose to prominence
only in the later half of the last century, yet
today it holds a legitimacy that rivals hard
science. We must remain skeptical of the
objectivity of medicine, since, as this research
indicates, those who practice medicinethe
physicians themselvesare greatly influenced by
market
forces.
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