For over two centuries, the mental health field, and psychiatry in particular, has actively cultivated a “brand,” distinguishing itself as a remedy for societal ills, largely by adapting its philosophy and methods to the dominant social agenda. In 1793, when Dr. Philippe Pinel initiated reforms in the Salpêtriere and Bicêtre Hospitals in Paris where the insane were often held in chains, the field cast itself as moral reformer and protector of human rights, and thus mirrored the values promoted by the French Revolution and the Enlightenment. When democratic societies needed ways to decide which of its citizens actually had free will and could act as autonomous subjects, the mental health field obliged with criteria for the insanity plea, protecting citizens from both dangerous minds as well as judicial systems unschooled in the limits of human reason. During darker moments in human history the mental health field also complied, giving credence to the Eugenics movement, forced sterilization, and even the “extermination” of the mentally ill during the reign of Nazism. For better and worse, where society ventures, the mental health field followed.
By the late twentieth century, branding formally entered the field when Eli Lilly hired Interbrand — the same company that brands for Sony, Microsoft, Nikon, and Nintendo — to brand their new compound, flouxetine hydrochloride. This occurred at a time in US history when people were increasingly expected to function with limited support from the government, and health care was becoming a luxury item.
Flouxetine hydorchloride was eventually branded “Prozac,” a name believed to sound both positive and professional. It was marketed as easy to prescribe, relatively safe, as well as nonaddictive — unlike Valium, which was once the most widely prescribed psychological medication and is highly addictive.
Prozac hit the markets in 1987, giving Eli Lilly two serendipitous advantages. First, direct-to-consumer advertising began in the United States in 1982, creating a new avenue for pharmaceutical companies to reach consumers. Second, Prozac was introduced when the National Institute of Mental Health was gearing up to launch The Decade of the Brain.
You may recall the 1990s were devoted to creating awareness about the biological underpinnings of mental illness. Eli Lilly contributed to the fanfare with eight million widely distributed brochures titled “Depression: What You Need to Know,” and two hundred thousand posters outlining the symptoms of depression that encouraged sufferers to seek treatment. Through such educational campaigns, Eli Lilly extended its branding of Prozac to include the branding of depression as a disease common to millions and easily treated with medications. The mental health field also organized around symptom checklists and pharmacological interventions.
Today the “selling” of mental disorders as chronic diseases that need medications for treatment is not only under attack, it also appears out of sync with the shifting social milieu. The emerging norm in society, much like the emerging trend in marketing, centers on forging connections, building relationships, and creating transparency. And in the mental health field, experts aren’t always perceived as transparent, and consumers have become more self-reliant, including conducting their own research through the Internet on what ails them. Instead of experts, people often rely on the opinions of people with whom they are connected and share networks. These connections and networks inform choices people make, including the choice of mental health treatment.
Consumers also have increased choices about the services they seek. In a crowded field of life coaches, personal trainers, massage therapists, acupuncturists, nutritionists, yoga teachers, spiritual guides, and alternative healers — along with internists, general practitioners, OB/GYNs and other medical specialists with access to information about psychopharmacology and prescription pads — the mental health field faces increased competition. Collectively, we are vying for the same consumers’ time, attention, and dollars.
Furthermore, thanks to the Internet, people are better educated about options, more aware of consumer grievances, as well as knowledgeable of the internal conflicts dominating services like mental health treatment. And a brief visit to the blogosphere would show the mental health field has a number of disgruntled consumers and a questionable reputation. Although it is often said that stigma keeps people from accessing mental health services, I wonder what studies of the field’s reputation might also suggest about barriers to seeking treatment.
In a prior post, I quoted the scholar of international affairs, Dominique Moïsi from his book The Geopolitics of Emotion on his thoughts about twenty-first century globalization, which he characterized as emphasizing identity, thus marking an end to twentieth century obsessions with ideology:
“In today’s world, ideology has been replaced by the struggle for identity. In the age of globalization, when everything and everybody are connected, it is important to assert one’s individuality.”
The mental health field seems caught somewhere in the divide between ideology and individualism, still promoting belief systems like the Diagnostic and Statistical Manual of Mental Disorders, or notions about chronic mental disorders than often serve the ideology of mental illness as a disease more than people navigating a rapidly evolving marketplace as well as rapidly changing identities.
If mental health practitioners were to look at themselves as providers of a service within a crowded marketplace, and not as professionals within the larger network of healthcare, we might have a better sense of the “brand” that would lead to increased engagement with the people we hope to serve as well as to opportunities for cross-fertilization with other care-focused professionals. I think such a shift is crucial, because how we see ourselves as practitioners impacts how other professionals and potential clients see us. Such a shift would also suggest questions we need to ask ourselves in today’s globalized marketplace: Are we trustworthy? Is it easy to forge connections with us? Are we transparent?
For many of us practitioners, we see ourselves as healers and social reformers, devoting our lives to the betterment of others. We not only provide treatment, but also psychoeducation. We are specially trained to support people in crisis, despair, and feelings of chronic ‘stuckness’. Along with diagnosing disorders, we create safe spaces for self-exploration and growth. And perhaps part of our “branding” should relay these core values, knowledge bases, and the spaces and opportunities we create and not just disorders treated and methods used. Such a move would likely benefit the field, especially if we collectively became more transparent about how we see our role in society.
And transparency is important. Transparency relates not only to trust, but also to the issue of social responsibility. Again, quoting Moïsi:
“In a transparent world the poor are no longer ignorant of the world of the rich, and the rich have lost the privilege of denial. They may choose to ignore the tragedies of the developing world, but it is a choice they must make consciously and, increasingly, at their own peril. ‘Not to act is to act,’ the theologian Dietrich Bonhoeffer used to say. Today not to intervene to alleviate the sufferings of the world is a form of intervention.”
Given the damning statistics often quoted about the number of people in need of mental health care, and the relatively limited number of people who actually receive treatment, this issue of transparency needs to be taken seriously. There is a profound and unmet need for our services. And yet, often concerns and arguments within the field are more directed towards scientific reliability and validity than providing mental health care for all. Yes, having reliable and valid treatments matter, but perhaps we should show at least equal concern for how we can create services that treat the most people.
By their very nature, mental illness and ongoing states of psychological distress are isolating, increasing the likelihood of lost social support, unemployment, and in turn, poverty. In a social milieu that values transparency, connection, and shared social networks, having a mental disorder or suffering chronic psychological distress can be especially alienating. As mental health professionals, we know this. We also know people have a hard time seeking support when they need it the most. Thus, rather than expecting people to seek mental health treatment, perhaps it is time to acknowledge the mental health field’s social responsibility for getting services to people when they are most in need and in ways they would be most receptive to receiving.
Such an approach can also lead to better outcomes. For example, a study conducted jointly by the RAND Corporation and UCLA, and with several community partners, showed community-based efforts led to the improved treatment of depression by taking services to where people congregated, including barber shops and churches. According to the RAND press release:
“People who received help as a part of the community-led effort to improve depression care were able to do a better job navigating through the daily challenges of life,” said psychiatrist Kenneth Wells, the project’s lead RAND investigator. “People became more stable in their lives and were at lower risk of facing a personal crisis, such as experiencing poor quality of life or becoming homeless.”
And when treatment occurs within clinical settings, rather than approaching mental illness like internists or general practitioners who focus on treating diseases and a set population of patients, perhaps a better model would be the emergency department (without the chaos, noise, and sterile atmospheres), where addressing the most acutely ill or traumatized is prioritized, along with the commitment to serve everyone and at all hours. Creating such systems of care would also recognize that it is not only disorders that we treat, but also the wounds associated with violence, chronic stress, neglect, and inadequate support, which research like the Adverse Childhood Experiences Study shows are often root causes of mental distress and disorders.
If we think of the mental health field as like a company, we might then ask who we are more like — BP and Exxon, attempting to clean up their bad reputations as well as deathly oil spills, or Whole Foods, Google, or even Kaiser Permanente, taking seriously their consumers’ opinions as well as acknowledging their responsibility to society? Granted, even these feel good companies have their faults, but as consumers we have the power of both voice and choice with regards to the services and products they provide: we can complain and we can seek other opportunities. At the very least, the mental health field owes its consumers the acknowledgement that they have voice and choice — and that we take both seriously.
Moïsi, Dominique. 2009. The Geopolitics of Emotion. New York: Doubleday.
© 2013 Laura K Kerr, PhD. All rights reserved (applies to writing and photography).