Faustian Bargains

The story of Faust is that of a bargain made with the Devil–actually with Mephistopheles, the messenger of Satan. The deal is that during his life, a man can have anything and everything he wants: success, reputation, fame, women, things (fine homes, cars, boats, horses) in exchange for his soul after he has lived a long and happy life.

Faust himself was a professor who made such a bargain in the classic work of that name by the German writer, Goethe (pronounced “Gerter” but with the two r’s deemphasized). Other, similar stories include the earlier work Dr. Faustus by Marlowe; Oscar Wilde’s novel, The Picture of Dorian Gray; and, more recently, the 1950s Broadway musical Damyankees, adapted from Douglass Wallop’s book, The Year the Yankees Lost the Pennant. 

The first Faustian bargain in the mental health field occurred soon after the passage of the Medicaid program in 1965. Until that time, psychologists and clinical social workers rarely if ever considered what they did with their clients in any way medical. Even many psychiatrists, who are medical doctors, felt that their work was only partly medical.     

With the coming of Medicaid, and the huge amount of federal money it made available, the pressure on all the mental health professionals to behave as though what they did was medical increased tremendously.

This meant that, if psychologists and clinical social workers began to behave like psychiatrists and begin thinking of their clients as in some way sick (as opposed to showing behaviors that were the product of abuse, violence, neglect, parental distancing, etc.), diagnose their clients, call their clients patients, and participate at least passively in the medicating of their clients, then these professionals could share in the governmental largesse formerly available only to medical doctors.

That was the Faustian bargain: non-psychiatric mental health professionals sold their souls (and ultimately the dignity, and even the physical health of their clients) for money–lots of money.

Well, the party’s over. Mephistopheles has come to claim his side of the bargain. It is now clear, as psychologists and clinical social workers should have known all along, that so-called mental illness is a metaphor, that their clients are not sick in any genuine medical way, that psychiatrists, despite their promises, have not been able to demonstrate any biological marker for any so-called mental illness, and that the medications they encouraged their patients to take have usually had little effect and have often done much more harm than good.

 

The second Faustian bargain that has occurred in mental health has not yet come due. The bargain was struck when the large pharmaceutical companies realized that: (1) The diseases that Americans, as well as the residents of the other industrialized nations, had died of in large numbers at the beginning of the 20th century (typhoid fever, measles, scarlet fever, whooping cough, diphtheria, tuberculosis, etc.) had been largely eradicated; (2) The diseases that Americans were dying of at the end of the 20th century (heart disease, cancer, stroke, chronic lower respiratory diseases, accidents, diabetes, Alzheimer’s disease, influenza, pneumonia, etc.) were largely diseases of life-style and therefore to a great extent preventable by changes in that lifestyle, and not likely to be modified in any great degree by medicines; and (3) If each drug company’s returns on investment by its stockholders were to be maintained into the 21st century, drastic steps would have to be taken.    

Enter Mephistopheles! First, the pharmaceutical companies made small changes in the chemistry of some of their best-selling drugs to protect them against competition by generics when their patents ran out. This, however, was only a partial solution. A much better solution was to find new diseases that existing medications, or medications close to final product phase, could be targeted against. It was helpful, as these new diseases were “discovered,” that the United States had, under pressure from drug companies, recently passed a law permitting the direct advertising of medications to the public–as opposed to restricting their marketing to physicians through “detail men” (and women).

It is, of course, difficult to find new diseases. The process is likely to be time-consuming and expensive, and one would frequently not know, in a specific case, whether the new disease was really new, or just some variant of an already well-establish one.

The answer provided by the drug companies has been to create new mental illnesses (along with a few dubious quasi-medical ones like restless leg syndrome and erectile disorder). This creation of new mental illnesses (e.g., adult ADHD) is the reason why the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has doubled, even tripled, in size and number of “diseases” over the past 40 or so years. It has also led to the creation of captive populations on whom drugs can be forced (the term is NOT too strong). The TeenScreen program is one example. Other actual or potential captive populations are prison inmates, residents of nursing homes and, of course, anyone labeled with that most fictitious of all illnesses, mental illness. 

As I said at the beginning of this page, this bargain has not yet come due–but it will. People will not be fooled by 21st century neurotoxin salesmen any longer than they were fooled by 19th century purveyors of snake oil, elixirs, and potions. But in the meantime much damage is being done.