Advertising is as much a part of pop culture as deliberately created works of art. Here in the United States, one of the most lasting contributions to perceptions of mental illness in society has come courtesy of the pharmaceutical industry, which spends an estimated $2.5 billion annually on reaching the public through advertising. Most people who have televisions or magazine subscriptions in the US have encountered pharmaceutical advertising, sometimes for products so vaguely described and marketed that viewers aren’t actually sure what they are for.
There is considerable controversy over the practice of marketing pharmaceutical products through direct-to-consumer advertising and this practice isn’t legal in all regions of the world. In Canada, for instance, drug companies cannot place TV ads for their products. The widespread ubiquity of television advertising for pharmaceutical products here in the US plays a big role in how people think about mental health and appropriate treatments for mental health, especially depression.
I’m sure I’m not the only one who remembers early Prozac® ads, featuring characters engaging in heavy-handed metaphors like opening the blinds to “let the sunshine in.” Or the series of cheery, upbeat ads for Zoloft® where mental illness is turned fuzzy and cute as the advertisement simplistically explains what the drug does and how it’s supposed to benefit you.
Many of these ads start with a depression-as-tragedy narrative; a sad-faced character mopes across the screen with woeful piano music as a background while the voice over talks about the benefits of the medication. Once the character gets the medication, the sun comes out, baby animals frolic, the clouds go away. They rely on a lot of very basic metaphors for mental illness, depression in particular, that make it seem like a very uniform experience. People with depression spend all their time being sad, and are never, ever happy, in the world of pharmaceutical advertising.
One consequence of framing depression the way we do is that when depressed people have good days or happy periods, it is assumed that they are faking. This can have very real consequences when it’s your insurance company looking at your Facebook page and deciding that you are obviously not depressed, and thus don’t need benefits. There’s an expectation of depressed people that they perform sadness at all times, or they will be met with suspicion.
This advertising also suggests that pharmaceuticals provide an instant cure for the symptoms of mental illness, voice over warnings about increased suicidal ideation in patients on some classes of medications aside. For people who seek medications to manage their mental illness, the lack of instant results can be frustrating for those expecting a TV commercial experience. The endless dosage adjustments and switches between medications that may be necessary to find a balance point in real life aren’t shown in pharmaceutical advertising. For patients, it can feel like you’re doing it wrong when the medication doesn’t work as promised; no tiny birds show up to sing you to work in the morning, you don’t suddenly feel more confident at parties.
And for people around a person with mental illness, the failure of the medication to work as expected can also become a source of tension and frustration. When the patient starts taking the drug, there may be an assumption that she should be “fixed” now, and no further work is necessary. Family and friends may push the patient; why do you still need therapy? How come you’re mopey today, I thought you were taking drugs to prevent that? Why isn’t the drug working yet? Are you sure you’re really depressed?
This can translate to lack of support. Patients should just take a pill to treat their mental health conditions, according to the narrative in pharmaceutical advertising, when the truth can be more complicated. Many people need, or can benefit from, therapy, for example, yes, even while taking medications. Others may discover that medications just don’t work for them, or they don’t like the way they feel on medications. And all patients need support from friends and family, because everyone experiences bad days and setbacks. Medication can be an incredibly valuable tool, but it is not the only tool, and it doesn’t work uniformly.
The understanding of mental illness mediated by pharmaceutical advertising tends to be simplistic, as though it can be something easily resolved: If you need fresh paint for the bathroom, go to Sherwin Williams; if you need treatment for your depression, pop a few pills. In a bootstrapping culture like the US, this can be a dangerous precedent to set, as it creates the idea that taking medication is “easy” and that people who want to use medications as part of their treatment plans aren’t willing to work hard to get better. This attitude undermines the complexity and variation of mental illness and it also contributes to the culture of shaming that surrounds pharmaceuticals and other forms of therapy. People who choose to use medications are “taking the easy way out” while people who do not should “just take some pills.” There is no way to escape this damned if you do, damned if you don’t double bind.