Original subtitles

- People are becoming more and more anxious.

More than a third of us feel the world is a

more frightening place than it used to be.

- By age 32, 50% of the population might qualify

for an anxiety disorder.

- For an estimated 10 million Americans,

fear of social situations can be totally debilitating.

- I'm a 40-year-old man in a 12-year-old body.

- One of my friends said,

"For people like you, we used to pour buckets of cold water

"on them as they lay in bed.

"That's what you deserve."

- If they can fix their anxiety with a pill,

that's just as appealing as discovering

that you can make your dinner with a microwave oven.

- [Allen] The country is bathing itself

in prescribed drugs.

- Oh, there are many, many unhappy people out there

in the real world that are,

"Oh, I have psychiatric illnesses."

The ultimate risk in all is that

we've psychiatrized the entire population.

We've ended up in a situation

where virtually everybody has some kind of disorder.

That's crazy.

[cars honking] [crowd muttering]

- The number one prescription people come

to the pharmacy for is anxiety.

Wouldn't you say, about three-quarters

of what we have here is for anxiety, Mark?

About three-quarters of the things

in the pharmacy are for anxiety.

It's kind of a sad thing, it's a tragic thing, really.

- [Narrator] This is a story about a society on edge.

A place where our culture, the very way we live,

is leaving us feeling more anxious than ever before.

- We're normally anxious because life is dangerous.

Many of us are vulnerable to losing a job

or being underemployed.

We can't manage whether we're gonna get a disease

or not most of the time.

- The other factor, I think,

is really important is isolation.

So, that sense that really nobody does have your back.

The collapse of meaning, so that where we all used

to sort of trudge out to the same church,

and even if we didn't explicitly believe in God,

we had a general consensus about it.

Now, we have none of that, so that's very anxiety-provoking.

- [Narrator] Once considered an obscure and serious illness,

anxiety is now a big part of our cultural identity.

- 18% of the U.S. population is said

to have an anxiety disorder.

So that's pretty high, certainly higher than depression,

higher than bi-polar disorder, higher than schizophrenia.

- Modern life is taking its toll.

Anxiety about terrorism, increasing fear of crime.

More than a third of us--

- [Arthur] You can't avoid hearing about anxiety

if you're in a media-sophisticated setting.

- 66% say the economy is contributing to our fears.

- And I think in a setting like that,

we become socialized to those ideas.

- [Narrator] All over the world,

a sort of psychiatric-perfect storm has been brewing.

New diagnoses for anxiety, prescription-happy GPs

and a hectic society have all collided

in the early 21st century

to effectively turn us all into mental health patients.

- More and more people who have normal worry

and anxiety are being diagnosed as having a mental disorder.

- It's become extraordinarily prevalent in our culture

as a reference point for how we're all feeling

without us necessarily understanding

what it is that we're talking about.

- [Narrator] What has changed?

Or has anxiety always been with us

and only now taking its place in the cultural spotlight?

To answer that question,

we need to know what exactly is anxiety.

- So often there's a confusion in the minds of people

when they're speaking and they're talking about anxiety.

Are they talkin' about somethin' normal?

Are they talkin' about something extra-normal?

Are they talkin' about somethin' pathological?

Is it a disease?

Is it a symptom?

- [Narrator] The dictionary describes it as,

"A feeling of worry, nervousness or unease,

"typically about an eminent event

"or something with an uncertain outcome."

In reality, it means very different things

to different people.

- A welling up of what I used to call panic juice.

I know that sounds weird, but it felt like there was

this volcano of panic juice coming from the stomach

and then into the rest of me.

- It kinda feels like something's always chasing you.

That you are always trying to get away

or trying to get somewhere.

There's something always right behind you coming for you.

- It's just something your brain does to you.

It's something you see that triggers the brain,

like the alarm goes off. [beeping]

I thought my heart was stopping.

I'm not lyin' to you, I thought my heart was stopping

and I thought I was dying.

That may sound a little like crazy, but I'm not lying.

- It's not a productive fear,

it's more of a

paralyzing fear.

- Well, there's just every day anxiety.

Missing the subway when you're late for work.

Trying to get to an appointment and you can't find a cab.

It's just, the city is fraught with it.

- [Narrator] The experience varies

because anxiety occurs on a spectrum.

At one extreme, it's a crippling disorder.

At the other, a normal, even healthy part of daily life.

- The anxiety is not all bad.

Think about, how in college did you keep yourself up late

at night studying for that test to get a good grade?

Actually, it was anxiety that got you to do that.

- It's normal to be anxious which is a form of fear.

It's just a fear of what's going to come in the future.

However, when that fear

or that anxiety becomes disconnected from the situation,

let's say there is no danger in the environment

and you are still worried, still anxious, still fearful,

that's when we are talking about anxiety disorders.

- Sometimes I'd look at ordinary objects

and it would cause me to be just stimulate a panic response.

I'd look at a teapot and be afraid of it.

Why would I be afraid of a teapot?

- I get the same kind of feeling someone would get waiting

outside their exam room for the test,

but I'd have it all the time.

- If you can see the tiger through the brush

and you're fearful, hey, that's a rational response.

If you know the tigers have been dead for 1,000 years

and you're still fearful of them, then that's anxiety.

- I was watching a TV show

and I saw something about someone choking

and nobody did anything to help him and it scared me.

I went to bed the next night and then next morning,

I was afraid to swallow.

I don't know, it just freaked me out, really.

I couldn't eat because I was afraid I was choking

and then I was gonna die.

And then, eventually we went to a psychiatrist

and I was diagnosed with anxiety.

- [Narrator] Today, people like Erin and Lucas,

who meet the criteria of an anxiety disorder,

are most likely to end up on medication.

But as the conversation

about life's daily anxieties grows louder and louder,

more and more people who think of themselves

as normal are considering using pills

to deal with everyday life.

[frenetic music] [cars honking]

- For me, anxiety is not having control over my life

in any environment.

I'm at work and my shoulders are up here

and I literally have to say, "Down, down, shoulders,"

because they are up at my ears.

[frenetic music]

I don't know how I'm managing?

- You're kind of not. - I'm not. [laughs]

And especially when you have a four year old

and you know, we're looking into schools for her now.

- [Friend] Oh, and private schools.

- We are looking into--

- And is Alan working? - No. [laughing]

- Okay. [somber music]

- He was laid off right after the crash in '08.

So we have one income

and a mortgage and you know it's very difficult,

especially living in New York City.

There are a lot of people competing for your job.

There are a lot of people competing

for that seat on the subway.

There are a lot of people who get to the farmer's market

before you do, [laughs] and buy up all the corn

that you were going to cook for your guests that night.

- I heard a story about parents dropping off their kids

and sort of clogging up the street in front of the school

and they weren't dropping off correctly.

And eventually, they had to be threatened

with putting a mark on their child's permanent record.

[laughs] And this was a preschool.

- I still, sometimes, have trouble sleeping

and I still, sometimes, have some hyperventilation.

I have a lot of tension and I clench my teeth a lot

and it's destroying my teeth.

The traditional gender roles are kind of reversed

in my household.

So I think that's another thing that plays into it,

is that I'm not the mommy

that a lot of other kids have.

I'm the one who goes to work everyday

and that she sees basically an hour a night and on weekends.

[somber music]

You feel completely helpless.

You feel like you have no control over your own life.

- We get ourselves into a situation

where we think that we're rational

and that we can have perfect control over our experience.

And then when we lose control of that experience,

which of course we're gonna do

because there's so many other elements involved,

it's terrifying.

We are pushing ourselves to the edge

of our confidence and competency,

and the result is that somebody who thought before,

"Well, I'm gonna be okay,

"I can just keep myself cool and collected."

Now, they're so freaked out and so stressed

that they're gonna reach for, if they're offered

which they often are by a GP,

they'll say, "Yeah, you know what,

"maybe I better take a pill

"because I really need to keep my cool here."

- [Narrator] According to the World Health Organization,

disorders related to dread are

now the most prevalent mental illnesses on the globe.

- On the one hand, we all are anxious.

Right now I'm anxious about whether my car, parked outside,

is gonna get a ticket or not.

But anxiety is also a pathological emotion

and that is not a normal experience,

'cause anxiety can be crippling.

[somber music] [birds singing]

- I would get heart palpitations,

this tightness in my chest,

and not really understand what was happening

and losing my breath.

I just had no idea what was going on.

- [Announcer] Vorsky with a nice chance

as she moved in on goal to test Kendra Fisher.

- [Announcer] Oh, what a stop!

[whistle blowing] [crowd cheering]

- [Narrator] Kendra Fisher was on her way

to a spot on the Olympic hockey team

before anxiety began to take control of her life.

- It's this secret you wanna keep

and this thing you don't want people

to know you're dealing with.

So, to then have to try to explain to people

why I wasn't okay goin' out for dinner,

I wasn't okay drivin' down the street.

It got to a point where I wasn't okay leaving my apartment.

I lost about 47 pounds in a month-and-a-half.

I couldn't eat.

I couldn't sleep.

I was just an absolute shell of myself.

- [Narrator] When her condition became unbearable,

Kendra was forced to retire from hockey

just weeks before realizing her dream

of joining Team Canada.

- It was the one thing that

I had spent my entire life wanting.

And you know, where, where do you go after that?

- [Narrator] Since touching bottom several years ago,

a mixture of meds, psychotherapy

and lifestyle changes have steadied Kendra.

But she's still unable to dine out in public

or go to a concert without risking a serious attack.

- [Kendra] Heaven forbid I forget to take my pills

and that typically makes for a rough day.

- [Narrator] Today, an extreme case

of anxiety like Kendra's is treated

as a genuine psychiatric illness.

While someone like Jessica, for now at least,

falls just under the threshold of a disorder.

What separates them is still, for the most part,

a scientific mystery.

[lively harpsichord music]

- In the 17th century, if you were anxious or depressed,

then it was thought to be the result of demonic possession.

This then leeches away, and by the end of the 18th century,

the population as a whole has stopped believing

in demonic possession and has started believing

in clinical medicine.

Anxiety was seen as an aspect of psychotic illness.

That means the presence of delusions and hallucinations.

- [Narrator] Early cures varied from spa treatment

to special diets, prayer, even fresh air.

- But then, the huge change in medical interpretations

of anxiety comes with the psychoanalysts,

comes with Sigmund Freud.

When Freud says, "Yes, it is very much a disease of its own,

"anxiety neurosis."

- [Narrator] Treatment was evolving, too.

Spas and physical therapies gave way to barbiturates

that produced sensations from mild sedation,

to total anesthesia.

These were the first psychoactive drugs.

- Barbiturates, the sleeping pills

that have colorful names like goof balls, red devils,

yellow jackets, blue heavens and rainbows.

Pep pills and sleeping pills, when improperly used,

can be just as dangerous as taking dope.

- [Narrator] By the 1960s, Valium-style drugs,

the benzodiazepines, had taken over partly

because they were considered less dangerous.

And since the late-1980s, the Prozac family of drugs,

or SSRIs, have dominated treatment for anxiety.

These work, in theory, by increasing the level

of serotonin in the brain.

- We have no idea how it works.

Somehow, you take it every morning

and your anxiety goes away.

What does it matter that we don't know how it works.

One of the issues is that there are many side effects

and the less that we know

about how drugs work, therapeutically,

the less we're going to know about how they may work

to cause negative or adverse reactions.

- [Narrator] For all of its many forms,

anxiety is still not easy to see with the naked eye.

Today, millions in research dollars are spent

on neuroscience in the hopes

of finding the next big breakthrough.

- All right, so what we have here,

is we have an animal that's been implanted

with fiber optics directed at a part of the brain,

called the hippocampus,

that we think is important for anxiety-like behavior.

This maze measures the animal's innate anxiety,

its innate fear of open spaces.

When we keep the light off,

the animal will behave like a normal mouse.

It'll basically spend all its time

in these close parts of the maze.

When we turn on the light

and activate these specific circuits,

the animal will now start

to explore the open arms of the maze.

That suggests that we can regulate

the animal's anxiety state.

And so if we can discover new circuits in the brain,

we can now create better drugs

to alleviate anxiety in humans.

- [Narrator] While researchers try

to map anxiety in the brain,

the search is on for the genes that trigger it all.

- Psychiatric disorders run in families

and that basically tells you

that there is a vulnerable genetic terrain

in certain individuals.

We are only at the top of the iceberg.

We've found a few of the genes involved,

but probably more than 90% are still missing.

- [Narrator] For now, anxiety is understood

basically as a list of symptoms observed

by patients and doctors

and collated since 1952 in what's known

as the Bible of Psychiatry,

the Diagnostic and Statistical Manual of Mental Disorders,

or simply, the DSM.

- The role of the DSM is really very simple,

it's a long list of mental disorders

and it helps us

to locate our patients, you know, within that spectrum

of psychological suffering.

We can't take a brain picture

and we have no blood test to tell us,

"Oh, yes, this is anxiety."

We depend entirely on patient's telling us how they feel.

- The most important function of the Diagnostic Manual is

to set the boundary between normality

and psychiatric illness.

Now the trouble with this is,

that there is no clear boundary.

[friends muttering]

- [Narrator] Already, vague definitions of anxiety

in the DSM make it easy to over-diagnose.

- Overt sexuality used to be in the DSM.

- Right. - Yes, yes.

- 18-year-old boys, so it's, you know--

- [Narrator] In New York,

Jessica Scott has been reading the DSM

out of curiosity about her own anxiety.

Tonight, she's decided to self-diagnose with her friends

and see how many of them meet the threshold

of an anxiety disorder.

- I'm curious, though, let's take a look at the DSM.

This is the diagnostic criteria

for generalized anxiety disorder, okay.

[friend singing]

So let's see what it says. [friend laughing]

And let's see what we think about it.

- Because now everything's a syndrome.

- "A. Excessive anxiety and worry.

"Apprehensive expectation occurring more days than not

"for at least six months."

- 45 years. [group laughing]

I've been suffering.

- All right, who wants to read the next two of these,

'cause this is givin' me a headache.

"Restlessness or feeling keyed up or on edge," check.

"Easily fatigued," yes.

"Difficulty concentrating or mind going blank."

- [Friend] This is perimenopausal.

[group laughing]

- Well, that is also perimenopausal.

"Muscle tension, sleep disturbance,

"difficulty falling or staying asleep," all of the above.

- So here's the thing.

Everybody in the world--

- Yes.

- Has been experiencing anxiety.

So what's the label that we're all experiencing?

- Well, for you it's-- - Generalized anxiety?

[group laughing]

- [Friend] For you, yeah.

[group laughing]

- [Narrator] Using the DSM to diagnose anxiety

at a dinner party is, of course, far from an exact science.

But the same is true even for the professionals

in a case where the patient is genuinely on the fence.

- Can I turn left out of here?

Oh, a bike!

Oh, don't do this to me!

Oh, my God! [frenetic music]

If I have to focus, I can't.

I can't listen to anything,

I can't have anyone talking to me.

Driving is a big one.

Like everybody experiences anxiety over exams and stuff,

but I think I experience it a little bit more?

I don't know if it's a little bit more or the same?

Or, I don't know if people are better dealing than I am?

Or, I don't know?

My name's Stephanie and I was wondering

if I could talk to one of your counselors?

- Sure.

- Anxiety on the campus is huge.

And we'll see in the neighborhood

of about 11,000 students in Health Service.

About 28% of all the students

we see have an anxiety disorder.

- Little things will set me off.

My first lab of this year,

I spilled reagents all over myself

'cause I did my calculations wrong

and the worse I do, the more I freak out.

It just sort of compounds.

The fact that I'm even thinking about medication is strange

for me because I don't like taking it.

- Because we expect to be more happy and fulfilled

than the average human life is going to be,

we start to become open to the idea

that our unhappiness is somehow pathological or a disorder

and that it deserves to be treated.

That's a real modern phenomenon,

to take the complexity and enormity of human emotion

and turn it into a treatable illness.

- If you have an illness that can be corrected

with a new boyfriend or a check for $5,000,

then you probably don't have a psychiatric disorder at all,

even though you'll be given a psychiatric diagnosis today.

- I would definitely say most students are

probably looking for an easy way out

because there's so much that's expected of us.

Like, a lot of people have a job

while they're going to school full-time

and having to pay off loans and things.

I know people that are getting second degrees

that are paying student loans off from before

while getting more student loans.

So I can see people like, "Well, I can take this pill

"and it'll be gone in 30 seconds,

"or I can do this exercise for 30 minutes."

I can see why people would find that to be the easy way out.

- They'll come in having researched on the internet.

They'll read into what symptom profile

they believe that they have

and they'll say, "Well, this is what's prescribed,

"this is what's recommended and I'd like to get that."

We have students coming in and asking for specific drugs.

So, you seem a bit nervous to me even right today.

- [laughs] I have a little bit of social anxiety.

- They're overwhelmed.

It's kinda this vague overwhelmed.

They feel that they can't meet their deadlines,

that there's just too much work,

they don't know where to start.

- I can cope most of the time, at least I try to,

but it's getting to the point

where it's too much and I can't.

- What you have to realize is that it's in a continuum.

There is the normal adaptive response

and when it gets exaggerated,

you fall into the anxiety disorder.

But there it is arbitrarily cut off between the two.

- In the majority of cases in the anxiety disorders,

all I have is your report to me.

And so that creates a little bit of subjective problem.

[cars honking] [frenetic music]

- [Narrator] Because of that subjectivity,

anxiety is easy to over-diagnose.

At the same time, GPs are often too busy

to look beyond medication for the answer.

Drug companies understand this better than anyone

and they spend a fortune marketing to doctors

and consumers alike, trying to bring us all

under the pharmaceutical umbrella.

- It's like I can't participate in life,

like I'm too busy worrying.

I don't sleep at night.

- [Announcer] Paxil works to correct this imbalance

to relieve anxiety.

- I think what's happened over the course

of the last 30 years is a kind of perfect storm

in psychiatric diagnosis.

- The most common symptoms include rapid heartbeat,

trembling, sweating, tense muscles--

- People have to understand that these diagnoses

that one hears on every street corner are diagnoses

that are being marketed for commercial profit.

They don't necessarily correspond at all

to what your underlying problem is.

- Medicalization is a huge, huge issue.

And psychiatry is the easiest area to medicalize

because we don't have the biological gold standard.

- The country is bathing itself in prescribed drugs.

There's already an enormously high rate

of diagnosis of anxiety disorders.

And in a recent study, it turned out that by age 32,

50% of the population might qualify for an anxiety disorder.

Get that.

Age 32, 50% of the population might qualify

for an anxiety disorder.

- [Narrator] To qualify,

patients must meet the criteria published in the DSM.

It's a document that is always being revised,

often to include more and more symptoms and new diagnoses.

It's a trend that worries former chairperson,

Dr. Allen Frances.

- It seems like the system is way too loose already

and what DSM-5 is suggesting is to open the gates way wider

and make it much easier to get an anxiety disorder.

There's a new proposal for a diagnosis

of mixed anxiety-depression that would be, I think,

very much equivalent to the everyday worries, tensions,

stresses, problems that all people have.

And this is likely to become, from nowhere,

the most common diagnosis in psychiatry.

This would be a needless increase of psychiatric diagnosis.

A medicalization of normality,

making pathological the worries and troubles

that are a natural part of the human condition

and that we shouldn't turn routinely

into a medical disorder.

- [Narrator] One of the doctors charged

with reviewing anxiety disorders

for the new DSM is Helen Blair Simpson.

- Mixed anxiety-depression is a hotly contested issue.

This is something that people worry about

and there's always that sort of balance

between how do you make sure someone

who is ill gets the diagnosis

and how do you make sure that someone who's not ill doesn't.

- This session really continues the road to DSM-5.

- [Narrator] Perhaps the most important psychiatrist

in the world today is Dr. David Kupfer.

As chair of the DSM-5 Taskforce,

he is the man with the final say on what will be

and what won't be a mental illness.

- What we all were asking ourselves to do was

to basically look at everything that was in the DSM-4

and say, "If it's working well, leave it alone."

Nobody has been instructed [laughs]

to look for more disorders.

We are making changes

because we believe that will serve us better

in terms of dealing with patients and families.

- I think that the DSM-5 has an important job to do,

but it's doing just the opposite

of what I would be suggesting.

I think that the appropriate function

of psychiatric diagnosis now,

should be to try to tame the tiger.

To try to indicate in the manual

with big, black-box warnings,

"This diagnosis is being overused.

"Here are the key steps to making sure

"that you're making this diagnosis appropriately."

Instead, what DSM-5 is doing is opening the floodgates.

- The number of diagnoses

in the DSM system continues to increase.

In reality, if you look at the different forms of illness,

there are only four or five major forms

of psychiatric illnesses, there aren't 400.

This is a classic conflict

between the splitters and the lumpers.

Splitters are people who say, "We must make evermore

"finely differentiated distinctions among kinds of behavior

"that we consider to be pathological."

The lumpers say, "Well, you know, there are only

"about four or five things that can really go wrong."

I'm very much a lumper,

but the future belongs to the splitters.

[somber music]

- [Narrator] Imagine a society

in which all the new disorders

currently proposed for the DSM-5, were accepted

and became real diagnoses

to be used in everyday medical practice.

- They'll go from period to period, from decade to decade,

from saying Homosexual new-ality is a disorder,

to saying overeating is a disorder.

To saying whatever the thing of the day is

that people are not necessarily comfortable with,

that they may decide is disordered.

So, in this funny, funny way,

we've actually compartmentalized our entire,

sort of, human personality into billable coding systems.

- For example, my wife died on March 6th of this year.

I had a grief experience after that.

The symptoms I had, couldn't sleep, didn't want to eat,

felt a lack of energy, sad,

those are the symptoms of depression.

Now, it used to be that we said that after a year of grief,

if you still had those symptoms,

then you had a depression, not grief.

What do we say now?

We say if after two weeks of the death of a spouse,

a child or a parent, if you still have those symptoms,

you can be diagnosed as having depressive disorder.

- It's very clear to me that it's not a question

that too many people are getting too much treatment.

I think, to some extent, there are a lot people

who are not getting enough treatment

and I worry more about that, to be honest with you.

- A new diagnosis in psychiatry is dangerous

because tens of millions of people may get medicines

that previously, they wouldn't have gotten

and those medicines may not be helpful.

The biggest beneficiary of diagnostic inflation is

obviously the big pharmaceutical companies.

- You'd have to be stupid as a manager

in the pharmaceutical industry not to realize

that your bread and butter is coming out of the diagnoses.

- Thinking about what the pharmaceutical industry will do

or not do is not primary on the agenda

of the taskforce, the work group members, et cetera.

We have no control

over how, if you will, companies, or researchers,

or organizations spend their money. [laughs]

- I think that's the disconnect.

And they don't feel sufficiently responsible

for the public health unintended consequences

of the decisions they're making.

They're thinking of the consequences only in their practice,

they're not thinking about the unintended consequences

in the real world.

- [Narrator] Unintended consequences,

like creating a disease, were nonexistent before.

That's the story of Paxil, notorious as the landmark case

in the multi-billion dollar game of drug marketing.

- Well, it was orchestrated by GlaxoSmithKline's PR firm.

It was a very concerted, very well-planned effort

to publicize this disorder.

- [Reporter] For some people,

the fear of interacting with others,

in fact, any social contact, is so acute that

they go out of their way to avoid all social situations.

This is a condition known as social anxiety disorder.

- In the 19th century, shyness was a virtue.

It was considered to be a sign of character

and of good breeding.

In our times, shyness is a pathology.

And we go to some length treating shy people

as if they were sick.

Well, are they really sick

or has the pharmaceutical industry discovered

it can make money off of treating shyness?

- Well, the thought

of public speaking can send butterflies--

- For someone suffering from a phobia--

- [Reporter] Tense muscles, upset stomach--

- [Reporter] It can actually make living

a day to day life almost impossible.

- I remember seeing all these stories coming out,

kind of at the same time in many different publications

and it was about this social anxiety disorder.

It all contained these fantastic statistics saying

what percentage of Americans suffer

from this disorder in a given year

and a lot of them contained the same experts,

seeing patients talking about the disorder.

- Studies have shown that Paxil can

dramatically decrease the symptoms

of social anxiety disorder.

- And so I was kind of curious about,

"Well, that's strange, all of a sudden out of nowhere,

"all of these stories are popping up at once,

"what's going on with that?"

- [Narrator] Brendan Koerner began his investigation

by trying to find out who was behind all these news reports

he was seeing on TV.

- When I would trace back the phone numbers they listed,

I would see they would trace back to PR firms

that just happened to represent GlaxoSmithKline,

which was the manufacturer of Paxil.

Which, just coincidentally, had just been approved

to treat this disorder.

- [Narrator] It turns out,

they weren't real news reports at all.

Cohn & Wolfe, Glaxo's PR firm,

was hired to produce a series of video-news releases,

easy enough to mistake for the real thing,

and sent them anonymously to the TV stations across the U.S.

- [Reporter] The good news for the millions

with this disorder is a medication called Paxil,

just approved by the FDA.

It is the first and only FDA-approved treatment

for social anxiety disorder.

- The company then hired PR companies and other companies

to encourage doctors to become, "educated,"

which it was really marketing.

And to encourage the public to reframe shyness

into a disorder.

- Paxil also developed a quite cynical strategy

of ghostwriting, whereby they contacted physicians

and helped them create stories

that could be plugged into the medical literature.

So, they buy credibility by the use of an academic.

- It's clear there was a lack of disclosure

and real efforts on the part of the PR firm

to obfuscate the fact that

this was ultimately something propelled

by a company looking to sell a product.

- Before the publicity strategy started,

there were 51 media stories around the world.

One year after the campaign had started,

focusing on the concept of,

"Imagine being allergic to people,"

there were 1.5 billion stories in the media.

So it's remarkable how

this became a kind of a societal concept.

- GlaxoSmithKline's revenues jumped by 40% in 2001.

They're not doing anything illegal at all.

It's very clear that they're not breaking any law

that I'm aware of.

I think the debate for people is ethics,

which is a very distinct thing from legality.

- As long as there is, sort of,

an untapped market of patients running around out there

who are not on your drug,

you are gonna be hiring the smartest marketing people

in the world to figure out a way to convince those people

that they have a condition.

- They put up all these signs

on bus shelters and on billboards,

and there was this phone number on there to call.

I remember calling it a few months afterwards

and you got this recording saying,

"This campaign is successfully concluded."

So they kind of wrapped it up pretty quickly

and just said they'd declared victory and moved on. [laughs]

- Yes, Paxil is a remarkable success story

in how a company has been able

to market a product by the,

you could call it, creation of a disease.

[receipts printing] [bottles clicking]

- Most of the time, Mark, it's circumstantial,

wouldn't you say, with the anxiety?

- It's all situationally. - Situations, yeah.

- These are all situational depression,

situational anxieties and they're treated with drugs

instead of just trying to counsel

and try to eliminate those factors that are causing it.

It's the easy way out.

- Yeah, it's like a crutch.

- For the patient and the doctor.

- Right, it's the fastest way to overcome.

- Everyone's happy, the pharmacy's happy,

everyone's happy but the patient.

Is the patient well served?

I don't think so. - No.

♪ You've got a headache

♪ And I've got some strange disease ♪

♪ Don't worry about it

♪ This pill will set your mind at ease ♪

♪ It's called Progenitorivox

♪ It's made by SquabbMerlCo

♪ It's life-enhancing miracle

♪ But there are some things you should know ♪

♪ It make cause agitation

♪ Palpitations

♪ Excessive salivation

♪ Constipation

♪ Male lactation

♪ Rust-Colored urination

♪ Hallucinations, bad vibrations ♪

♪ Mild electric shock sensations ♪

♪ But it's worth it for the drugs I need ♪

- The thing I found is they do work,

but they make everything very,

sort of an even shade of gray.

Funny things aren't as funny.

Sad movies don't give you goosebumps any more.

Poetry can't make you cry.

- I was very disinterested in things

I used to be really passionate about.

And even my boyfriend, I wouldn't,

you know, it's like, "Hey."

[laughs] I don't, I just didn't have

that kind of attachment to anything.

I felt really zombie-like.

- They wind up placing people on these drugs without,

for instance, any real sense of how difficult it is

to get off them, or what the side effects might be.

With these drugs, you can gain 50 pounds,

you can get Diabetes 2.

Like, they're crazy side effects.

- They are prescribed almost like candy,

more by primary care doctors, actually,

than by psychiatrists.

I always have the impression that patients believe

that psychiatrists are highly-knowledgeable

about the neurobiology and the underlying neurotransmitters,

which are the chemicals in the brain

that underlie mental illness.

And I think it is surprising when they find out

that we know very, very little about how these drugs work.

- They would give you the sample packs

and then prescriptions.

And then when you told them how things were working out,

they would recommend a different one,

"Try this one," and, "try this in combination with this."

Even though it is fun to have someone

who I tell my all friends is like Elvis Presley's doctor,

it really isn't a good way to control it,

it feels very artificial.

- We didn't discuss cognitive behavioral therapy

or any other kind of talk therapy that might help,

or changes in your diet or exercise that could help.

It was straight to the medication and to a really high dose.

- If the only tool you have is a hammer,

then everything you see is going to look like a nail

and it's the same thing in psychiatry.

If the only tool you have is a drug,

then everything you see is going to look like something

that's a medicable condition.

- Mental health has filled the whole space,

that in prior times,

was occupied by religion, morality and by common sense.

I feel there's a tragedy to this

and this is a tragic story.

- Social anxiety disorder is an intense fear

of everyday social interactions.

- That's really a life-impairing condition.

- It's in the newspapers all the time.

It's in the magazines.

It's on the internet, the television.

- Part of the reason anxiety seems to be prevalent is

because it is prevalent.

But another reason is because it's become part

of a vocabulary to talk in psychiatric terms.

- Come on up here, Christine.

- [Patricia] So we identify ourselves as anxious

in a way that we wouldn't have before.

- I've been taking Clonazepam lately for anxiety,

little blue pills that look a lot like birth control.

This guy I was seeing, thought I was super-protected.

[audience laughs]

I thought, "I might get pregnant,

"but I'll just be cool with it."

[audience laughing]

It was great, yeah, it was really fun.

'Cause it's taking very difficult situations

and making fun of them.

It gave me a really different perspective

and sometimes took the anxiety away

from situations and the fear

'cause I could just laugh about it.

I ordered a coffee at Starbucks the other day,

I heard, "Tall, nutty one!"

I was offended, they just yelled out my diagnosis.

[audience laughing]

- I don't think there's as much of a stigma

as there used to be.

So many people just openly discuss it now

and they just refer to their therapists

as though they were at their neighbor's house last night,

"I was at my therapist's last night."

I think there's really no odd response,

because they're all in therapy, too. [laughs]

- So we expect anxiety.

Each of us gets the so-called medical student syndrome.

You know what the medical student syndrome is?

When a medical student is taking a pathology course

and turning the page and reading about a new disease,

like let's say a melanoma,

and all of sudden, as he reads, he looks at his hands

and says, "Oh, my God, I've got a mole there,

"that could be a melanoma!"

- I'm sure that there's a cultural component, too,

because some cultures don't even have a word for anxiety.

It just doesn't exist in certain cultures.

It certainly exists in ours.

- [Narrator] In fact, anxiety has become

so much a part of the cultural discourse,

anti-anxiety pills are now the inspiration for art exhibits.

- Below the crate? - Yeah.

- [Assistant] I just want to make sure

that our placement is basically how you want it.

- Well, they're supposed to look like

they just spilled out of a pill bottle.

[crowd muttering]

We live in the age of anxiety.

There's a correlation between anxiety, in my view,

and advanced capitalism.

The pills that you see are for anxiety and depression.

And the thing that I really want people

to do is to talk about this stuff,

because it's a short-term fix

for a deeper problem in our society.

And I really do think we have to stop it

and if we just keep medicating ourselves,

we'll just kind of, you know, fall asleep

and that'll be the end of us.

- [Narrator] In the space of a single generation,

anxiety has merged from the fringe of mental illness

to become completely mainstream.

- We need to use both behavioral techniques

as well as medication.

- And what are the side effects of the medications?

- Sometimes we get aggression.

Such as going down to the park

and meeting a new animal, instead of being calmer,

the dog's a little more aggressive with other dogs.

So, let us know if that happens, but that'll be rare.

- One of my friends once told me, he said,

"Bill, we're living in an uninhabitable culture,

"no wonder you don't feel good."

Whether it's any different now

than it was through history, I don't know?

[suspenseful music]

- Back in the 18th century,

18th century London, Boswell's London,

believed that they were

in a fast-paced urban life on the Thames

and they were all just totally stressed out and so forth.

And they made that responsible for their symptoms,

so in a sense, there's nothing new under the sun here.

And the idea that, "Our lives have speeded up particularly

"so that now we're more anxious than ever before,"

is just a canard.

- People have gone through a lot of stuff in this life,

war, famine, pestilence, whatever.

It's like, "Come on, toughen up."

I think maybe in the former generations

that was more of the attitude.

I know they didn't have the medications,

weren't as good in those days.

Fresh air and laudanum and prayer.

- My mom, her generation I'm sure when she was growing up,

wasn't something that you really considered.

For her, it's a lot of, "Well, you know, walk it off,"

or, "Suck it up," and that sort of stuff.

- [Friend] Would get these fingernails.

[group laughing]

- [Narrator] What has changed over the years,

aside from perceptions,

is the way mental illnesses are defined.

- I mean, what's outside the human condition that's normal

if all of this is busy, it's messy, it needs therapy?

- [Friend] It's very scary.

- Okay, so, based on what we've all read together,

who has anxiety at this table?

- You know I! - Everyone!

[friend laughs]

- [Narrator] For Stephanie,

like so many university students,

it's all about whether or not to medicate.

- It's what I'm experiencing.

Like, is it normal?

I guess, like, I don't know, 'cause I kinda feel like

I'm freaking out a little bit more

than most of my friends in the classes are.

Or, I don't know if they're hiding it better

or what's going on?

- I will tell you, it's fairly normal.

What you're experiencing,

many, many students are experiencing.

It's hard to be at university.

- [Narrator] Instead of prescription meds, at least for now,

Stephanie gets a list of lifestyle changes.

No scary movies before bed,

warm milk, hot bath

and doing some breathing exercises regularly.

- One of the reasons I kind of go down this path is

that a lot of kids your age think that coming

and getting a pill's gonna solve the problem

and it's a temporary solution.

It really doesn't solve sort of some

of the lifestyle changes people need to make

to actually make themselves healthier.

It's really some coping strategies that they need to develop

that'll do them, really, much better in the long run

than to just kind of mask the symptoms.

Does that seem like a reasonable plan?

- Yeah, definitely,

especially 'cause I don't like medications. [laughs]

So I'm glad that I have better options.

- [Narrator] In some cases, however,

there may be no better option than to medicate.

- I get a lot of tension everywhere.

Okay, [sighs] I'm anxious, all right, okay.

[sighs] I also wonder if I should take a Clonazepam?

[laughs] [sighs] Okay.

I just express myself a lot better

when I take my medication.

- You know, everybody's scared to admit they're on them.

For me, it's simple.

I mean, if I had cancer, I would've gone on chemo,

I would've done the radiation,

I would've done what it was my doctor told me to do.

It's what I take to stay well and maybe that course

of therapy won't always stay the same for me.

Maybe someday that will change,

maybe someday I'll come off it.

But in the meantime, I'm treating myself for something

that makes me unwell,

so I can't beat myself up for it anymore.

- I think pharmaceuticals have their place.

I mean, they've saved people's lives.

And I don't think it should be the only route

and I don't think it should be the first thing

that a therapist pulls out of their toolbox.

And I think that's probably happening a lot.

That's why I choose not to, even though it has been,

it's recommended sometimes.

But that's my choice.

- [Narrator] In most cases, there are other ways

to deal with anxiety beyond taking a pill,

including changes in diet and exercise.

Mindful meditation has made its way into grade schools.

Yoga is a global phenomenon.

- So you'll start by just pressing the icon.

- [Narrator] There's even an app for anxiety.

- To me, anxiety isn't something

that you can sweep just under the rug,

you have to deal with it.

And I just have to remind myself to do that.

So, I try to take these little steps during the day

where I just say, "Okay, I'm just gonna breathe,

"I'm just gonna breathe and I'm gonna shut my eyes

"and I'm gonna count to five."

And then, start over.

And that seems to help.

- We have all have to deal with it.

Everyone has baggage that they have to live with

through their whole life, mine had to be anxiety.

[somber music] [rain pattering]

- [Narrator] But despite our best efforts to tackle anxiety,

as long as psychiatry keeps expanding its domain

and drug companies go on treating

your mental health like a business opportunity,

we will continue to medicalize the human experience.

- The biggest problem with being mislabeled

with a mental disorder these days,

is that you're very likely to get medication.

And in some instances,

the medication may be remarkably harmful.

Bottom line is that the manual

of psychiatric diagnoses should be cautioning

against over-diagnosis, rather than encouraging it.

- This is just a terrible development

if you include addictive disorders,

they say, "Three-out-of-four-people

"on a lifetime basis will have a psychiatric illness."

That's crazy!

- It's us, it's the doctors,

'cause we're the gatekeepers of the drugs.

We're the ones that write out prescriptions.

And one of the problems in psychiatry is

that the pendulum has really swung

far too far toward psychopharmacology,

or the use of medications.

- What we are doing, more or less,

is clinicizing human emotions.

So we're taking the experience of being human

in all its complexity and the way it used to be manifest

in song and in scripture and in theater and in poetry,

and we're turning it into a broken-down piece of biology.

[frenetic string music]