All language subtitles for The Age Of Anxiety 2013 1080p AMZN WEB-DL H264-TEPES

- 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]