Ingesting Placebo

Bibliographic Data

ID5854751
AuthorsElizabeth A Wilson (0000-0002-8105-0928), Elizabeth Wilson (0000-0002-1560-7417, corresponding author)
Year2008
Volume23
Issue55
Pages31-42
Publication date2008-03-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAustralian Feminist Studies (JOURNAL)
Journal identifiersISSN: 1321-7568 • E-ISSN: 1465-3303
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/08164640701827170
OpenAlexW4252490208
LanguageEN
Citations received7
References cited17

Click to increase image sizeClick to decrease image size Notes 1. The Hamilton Depression Rating Scale (HAM-D) has become the gold standard for psychological assessment of depression in clinical trials (Hamilton 1960 Hamilton, Max. 1960. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23: 56–62. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). It is a 21-item questionnaire that enquires into the severity of somatic and psychological symptoms such as insomnia, gastrointestinal disruption, agitation, mood, suicidal ideation, guilt and anxiety. 2. These writers argue that the pharmaceutical companies generate diseases (e.g. social anxiety disorder) out of ordinary personality characteristics (shyness) in order to widen the market for their products: For example, social anxiety disorder—the fear of being embarrassed or humiliated in public—was considered a rare disorder until physicians began treating it with Nardil (phenelzine) in the mid-1980s and then, later, with SSRIs such a Paxil. Today social phobia is often described as the third most common mental disorder in the United States. Similar stories can be told for obsessive-compulsive disorder and panic disorder (the latter was known among clinicians in the mid-1980s as the 'Upjohn illness,' after the makers of Xanax). As David Healy has pointed out, the key to selling psychoactive drugs is to sell mental disorders. (Elliott 2004 Elliott, Carl. 2004. "Introduction". In Prozac as a way of life, Edited by: Elliott, Carl and Chambers, Tod. Chapel Hill: University of North Carolina Press. [Google Scholar], 5) 3. This scepticism seems to be as ill-informed as the earlier endorsement of SSRIs. The media echo scientific information about antidepressants rather than analyse it. For example, the recent publication of a study on placebo and antidepressants in the American Journal of Psychiatry was accompanied by a press release from the Semel Institute of Neuroscience and Human Behavior (2006 Semel Institute of Neuroscience and Human Behavior . 2006 . News release. Placebo study frames depression treatment puzzle; Brain activity predicts treatment results before medication begin [sic] . 1 August. Available from http://www.newsroom.ucla.edu/page.asp?relnum=7194 [Google Scholar]) at UCLA, where the research was conducted. The study, which will be discussed later in this article, made headlines in the Wall Street Journal, Forbes, the Los Angeles Times, medindia.com, docguide.com, healthcentral.com and the online sites for various US television stations. Just about all of the online sites replicate the press release, adding little or no new analysis or commentary. 4. Every drug released into the markets of Western democracies is clinically tested against placebo. The question of placebo in relation to psychological conditions is particularly acute, as placebo responses still invoke questions about hysterical suggestibility (Evans 2003 Evans, Dylan. 2003. Placebo, London: HarperCollins. [Google Scholar]). A large proportion of the research into placebo pertains to pain management, another condition that notoriously resists conventional empirical measurement. This essay focuses quite narrowly on placebo in relation to the new-generation antidepressants. It is not clear that data on placebo in relation to, say, the management of pain, bear directly on the antidepressant debates. The physiological, historical and political mechanisms in play are different in each case, and each requires close attention in its own right. It is my suspicion, nonetheless, that the divisions between biology and mind described here would be found in most clinical trials. Such a division is not the creation of clinical trials alone; it is part of a much wider conviction that biological substrate is mindless, mechanistic matter that can be managed independently of other (psychic, discursive, economic, social) systems. 5. For more information see http://www.placebo.ucla.edu 6. The HAM-D was originally designed to be administered by a trained clinician (Hamilton 1960 Hamilton, Max. 1960. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23: 56–62. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), and as such is essentially interpersonal in nature. A key ambition underlying the search for biological markers of depression is the hope that such intersubjective, and allegedly unreliable, metrics can be circumvented. I take it to be axiomatic that attempts to evade the relationality of measurement and of data are misguided: a relation is not simply the smallest possible unit of analysis (Haraway 2003 Haraway, Donna. 2003. The companion species manifesto: Dogs, people, and significant otherness, Chicago: Prickly Paradigm Press. [Google Scholar]); it is the only possible unit of analysis

Anxiety · Hamilton Anxiety Rating Scale · Mood · Paranoia · Psychiatry · Shyness · Social anxiety · Medicine · Mental Health and Psychiatry · Pain Management and Placebo Effect · Psychology · Psychosomatic Disorders and Their Treatments