Abstract
The documentary Medicating Normal highlights the experiences of four individuals harmed by psychiatric medications, drawing on expert interviews to criticize the overuse of these drugs and offer insights into the historical development of this problem. Dave, one featured individual, turned to psychiatric treatment for anxiety. He describes himself as a worrier whose anxiety fueled his academic success. His accomplishments include earning two master’s degrees from the Massachusetts Institute of Technology and navigating a challenging military career. Dave experienced some initial success with his medication, but he eventually developed troubling side effects and decided to discontinue all medication. He blames the side effects and withdrawal symptoms for ruining his career and threatening his marriage.
Angie, too, describes herself as having had a successful life and demanding military career. After serving in Iraq, she was treated for PTSD with a series of psychiatric medications. She reports experiencing numbness and violent thoughts that horrified her. In a series of 10-minute psychiatric appointments, Angie was eventually treated with 17 medications at once. She expresses frustration with the lack of information she received about these medications as well as with the ongoing attribution of all of her symptoms to her psychiatric condition rather than the medications.
Rebecka and her parents turned to therapy and medication to help with the anxiety, isolation, stomachaches, and weight loss she experienced throughout her family’s frequent moves. However, Rebecka’s condition worsened, and she was hospitalized several times, beginning at age 13. Her parents explain that they followed the advice of medical professionals, who regarded her new hallucinations and other worsening symptoms as evidence of the progression of her disorder. Nonetheless, after discontinuing medication, Rebecka’s hallucinations stopped, and she returned to her prior condition. She was able to go to college, which she previously believed would be out of reach for her.
Shalamar, a waitress, turned to psychiatric treatment when late-night shifts interfered with her ability to sleep. She received a prescription for a medication in the benzodiazepine drug class, which she took for years without being informed of any long-term risks. She describes her ongoing struggle to discontinue the medication, including burning and crawling sensations in her body. Despite her psychiatrist’s opinion that her medication was not dangerous, Shalamar has joined a 2,300-member online support group for those struggling to quit benzodiazepines.
Medicating Normal also features interviews with several professionals. Allen Frances, chairman emeritus of the Duke University Medical School Department of Psychiatry, discusses the loss of “normal.” He explains that the definitions and diagnosis of mental disorders have come to encompass many people experiencing temporary stressors. Relatedly, navy psychologist Mary Neal Vieten states that although grief is a natural response to the stressors of war, our culture has labeled this as not normal. The film also includes an overview of the historical development of current psychiatric treatment. Journalist Robert Whitaker discusses the psychiatric profession’s struggle to establish its medical legitimacy in the 1970s as well as the ways in which the pharmaceutical industry has taken advantage of medicalized understandings of mental illness to promote sales.
Medicating Normal is most appropriate for upper-level undergraduate classes and graduate classes. The documentary could fruitfully be used in sociology classes on mental health, medical sociology, social psychology, and sociology of diagnosis to discuss medicalization and the social construction of mental illness. In particular, instructors could draw on Medicating Normal to teach labeling theorists’ approach to mental illness, facilitating a discussion of how behaviors that break social norms come to be classified as mental illnesses and helping students to examine the power of professionals to apply and enforce these labels. Medicating Normal also illustrates how labels shape subsequent medical evaluation of individuals, offering students a contemporary example of Rosenhan’s (1973) study on this topic. Finally, the film features comments from individuals about their own experiences with receiving diagnostic labels.
Medicating Normal would pair well with Karen Kaiser’s (2010) activity “Social Constructionism, Mental Illness” in the Teaching Resources and Innovations Library for Sociology (TRAILS) database. The activity asks students to consider how the definitions of mental illnesses are socially shaped and change over time. Instructors will need to make some updates to the activity based on the disorder definitions in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association 2013). They may also wish to highlight changes that were made in the DSM-5, such as the removal of the bereavement exclusion from the depression diagnostic criteria (discussed in Hari’s [2018] article as the “grief exception”) and the introduction of separate male and female low-sexual-desire disorders, with accompanying gendered language (see Spurgas 2016).
The documentary could also be used as a basis for a discussion of trust in scientific and medical authority, a particularly relevant topic given the controversy over masking and vaccinations throughout the COVID-19 pandemic. The documentary highlights pharmaceutical companies’ selective dissemination of study findings and their strategic partnership with researchers at top universities, indicating the impact of these actions both on the public and on the education of medical doctors. Students could discuss the circumstances under which scientific findings are more or less trustworthy and the implications of this for how they believe the general public and fellow college students should approach guidance from doctors, pharmaceutical advertisements, and government health agencies.
The documentary has an accompanying discussion guide (Cunningham and Ractliffe 2020) that may be useful to instructors. The guide contains an extensive list of questions, touching on topics including what is considered a normal response to stressors, how mental illness should be defined, diagnostic labels, and informed consent. Some questions contained within the guide are leading and will need to be adapted to invite discussion that includes a broad range of student perspectives.
One shortcoming of Medicating Normal is that its emphasis on the normality of the featured individuals may lead students to confuse normalcy with lack of severity and, thus, to believe that the criticisms of medicalization and pharmacological treatment raised by the film apply only to those with low severity. Although the film does little to explore the extent of Angie’s suffering as a result of serving in Iraq, instructors could help students examine the meaning of normalcy by discussing the degree to which PTSD symptoms following war are both normal and severe. Another shortcoming of Medicating Normal is that there is limited discussion of alternative ways of helping those experiencing distress and mental illness, such that students viewing the film may believe that medical treatment is the only option in situations where intervention is needed.
To address both shortcomings, instructors may wish to assign the Invisibilia podcast episode “The Problem with the Solution” (Miller and Spiegel 2016). The episode discusses the town of Geel, Belgium, where residents welcome those with severe mental illness into their homes and community and accommodate many behaviors that would be considered non-normative in the United States. Instructors may also wish to assign Hari’s (2018) Vox article titled “We Need New Ways of Treating Depression,” which offers examples of community-based responses to depression. Hari’s article also provides students with additional insight into the limitations of the chemical imbalance explanation, which is referred to multiple times in Medicating Normal. Graduate instructors could assign Davis’s (2020) book Chemically Imbalanced: Everyday Suffering, Medication, and Our Troubled Quest for Self-Mastery, which gives a more in-depth overview of the historical use of psychiatric medications, the development of the chemical imbalance explanation, and interviewees’ understandings of their own suffering and diagnoses.
Instructors should exercise caution when using this film, given the sensitive topics it covers. The film contains multiple references to suicide, including Shalamar’s descriptions of her support group members’ suicides at 42:00, which may be triggering to students with a personal connection to the topic. Students should be informed in advance that the film discusses suicide, and in addition, instructors who show the film in class should consider skipping 42:00 to 42:52 or allowing students who do not wish to be present in class to view the film on their own. Furthermore, instructors should take care to acknowledge that medication is a valid treatment option, since students who take psychiatric medication may find the content to be offensive or distressing. Relatedly, viewing this film may discourage some students from getting help for mental health issues or from complying with medically recommended treatment. Therefore, it is important for instructors to emphasize the importance of seeking support and to share information about campus mental health resources with students.
Finally, students may be troubled by the documentary’s critique of medicalized understandings of mental illness. Since students have likely been exposed to advertisements and advocacy campaigns stating that mental illnesses are like physical illnesses, and therefore real and worthy of medical treatment, they may believe that the documentary challenges the legitimacy of mental illnesses or undermines stigma reduction efforts. It may be helpful to explain to students that research has shown that during the time period in which the U.S. public widely adopted a medicalized understanding of mental illness, there was not a corresponding decrease in stigma (Pescosolido et al. 2010).
Medicating Normal raises several issues relevant to sociological discussions about mental illness, providing students with a springboard for in-depth discussions of the ways in which our society defines and responds to mental illness and the implications for individuals, mental health professionals, and pharmaceutical companies. With proper guidance from instructors, this film has the potential to help students utilize sociological insights to reevaluate previous understandings of mental illness and examine how these understandings are situated within particular historical and cultural contexts.