Healthy Skepticism Library item: 19919
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Journal Article
Metzl JM, Riba M
Understanding the Symbolic Value of Medications: A Brief Review
Primary Psychiatry 2003 July; 10:(7):45-48
Abstract:
Abstract
How do psychotropic medications function symbolically and chemically? Scholars
from disciplines as far reaching as psychoanalysis, business and marketing, and media
studies have begun to explore the complex cultural meanings accrued by selective serotonin
reuptake inhibitors, mood stabilizers, and other drugs commonly prescribed by psychiatrists.
This article provides an overview of this growing body of literature and its relevance
to clinical practice, followed by a discussion of how psychotropic medications
have been shown to demonstrate symbolic properties at the contextual, economic, and
cultural levels. Such lines of inquiry have led to understanding of these medications as
transitional objects, commodities, metaphors, and icons. Ways in which understanding
the symbolic function of psychotropic medications is important for addressing adherence,
satisfaction, outcome, and a host of other important clinical issues are described.
Awareness of these symbolic meanings can help identify issues that arise in instances
when a discussion of medication, a seemingly fixed object, involves a host of elusive
expectations that patients and doctors bring to the examination room.
Notes:
Focus Points
•This article explores the complex cultural meanings accrued by selective
serotonin reuptake inhibitors, mood stabilizers, and other psychotropic
medications.
•Psychotropic medications have been shown to demonstrate symbolic properties
at the contextual, economic, and cultural levels. Such lines of inquiry
have led to understanding of these medications as transitional objects, commodities,
metaphors, and icons.
•Awareness of popular representations of psychotropic drugs can help
patients and doctors think about the role of culture in shaping their own
notions of health and illness.
•Understanding the symbolic function of psychotropic medications is important
for addressing adherence, satisfaction, outcome, and a host of other
important clinical issues.
Full text:
Physicians are often trained to think
about psychotropic medications in concrete
ways. Interns and residents, for
example, are responsible for absorbing
massive amounts of information concerning
the most intimate details of a
medication’s profile, ranging from its
half-life, to its mechanism of action, to
its volume of distribution. They learn
that the half-life of citalopram is
35 hours, the starting dose of phenelzine
is 15 mg, and that clozapine carries the
risk of agranulocytosis. In the process,
physicians-in-training master “the latest,
most authoritative information”
about medications, to cite the introduction
of the Physician’s Desk Reference
(PDR),1 and reproduce it in an endless
stream of Prite exams, Board tests, and
other multiple-choice examinations.
These efforts serve as an important
apprenticeship for careers where psychiatrists,
internists, family practitioners,
and other clinicians make innumerable
decisions about the interactions,
benefits, and untoward effects of the
medications they prescribe to their
patients on a daily basis.
However, physicians are perhaps less
attuned to the functions these medications
perform as symbols—metaphors,
similes, icons, and other abstract properties
that complicate thinking of pharmaceuticals
simply in terms of hard-andfast
facts. Symbolically speaking, medications
convey a host of connotative
implications that are difficult to recognize,
let alone to quantify. These range
from preconceived beliefs about drugs
that patients carry with them into the
examination room, to unspoken messages
of nurturance at play when doctors
prescribe (or choose not to prescribe)
psychotropic medications, to varied
social and cultural meanings attached to
these medications by the mass media,
fiction, television, advertisements, and
other popular cultural sites (Table).2-4
For example, the information contained
in the PDR is of secondary
importance when a 39-year-old mother
of two returns to her doctor’s office voicing
anger about the effects that the
physician caused by giving her divalproex.
Or when a 21-year-old college
senior points to the fluoxetine advertisement
in Newsweek and says “this is me”
when questioned about the reason for
his doctor’s visit. Or when a 43-year-old
businesswoman voices frustration over
paroxetine’s inability to help her secure
a desired promotion at work. In these
and countless other cases, factual data
about psychotropic medications is complicated
by the many, often contradictory
meanings of medication within the
doctor-patient dialogue. Thus, understanding
the symbolic functions of the
medications is as important as knowing
their elimination half-lives or suggested
dosing regimens.
This article reviews the symbolic
meanings of medications as they have
been described in an emerging body of
literature. Scholars from disciplines as
far reaching as psychoanalysis, business
and marketing, and cultural and media
studies have begun to explore the complex
connotations accrued by selective
serotonin reuptake inhibitors (SSRIs),
mood stabilizers, and other drugs commonly
prescribed by psychiatrists.
These studies provide evidence that psychotropic
medications have symbolic
valence at the contextual, economic,
and cultural levels. After briefly discussing
each of these levels, the article
concludes by suggesting ways in which
understanding the symbolic function of
psychotropic medications is important
for addressing adherence, communication,
satisfaction, outcome, and a host
of other important clinical issues….
