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MARINO PÉREZ-ÁLVAREZ
Department of Psychology, University of Oviedo, Oviedo, Spain
JOSÉ M. GARCÍA-MONTES
Department of Psychology, University of Almerı́a, Almerı́a, Spain
This article proposes the Charcot effect, in which clinicians describe what
they themselves prescribe. It is argued that the Charcot effect can be a critical
instrument for exposing how mental illnesses are invented in the process of
developing diagnostic systems and conducting psychopharmacological research.
We argue that the Charcot effect helps explain the expansion of depression
to epidemic proportions, the promotion of social phobia as a pharmaceutical
marketing strategy, the profile of panic disorder according to the available
medication, and the worse prognosis of schizophrenia in developed countries than
in developing countries. Having undertaken this review, we situate the Charcot
effect in relation to constructivist psychology.
309
310 M. Pérez-Álvarez and J. M. Garcı́a-Montes
become 224 in the DSM-III (APA, 1980), and reach 374 by the
DSM-IV (APA, 1994; with no additions in the revised text of 2000,
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As Healy (2004a) put it, “now this psychobabble has been all
but replaced by an equally vacuous biobabble, which in turn has
consequences for how we view ourselves, how we view the turmoil
of adolescence or school underachievement or, finally, moral and
criminal culpability” (p. 264). It is in such a cultural context that
we can identify the concept of neurochemical selves (Rose, 2003).
The paradox in all of this is that, as Horwitz (2002) argued, “the
ascendant belief that ‘mental illnesses are brain diseases’ is due
far more to the cultural belief that only biologically-based illnesses
are ‘real’ illnesses than to any empirical findings that the causes
of mental disorder are brain-based” (p. 156).
If against such a background we consider the fact that psy-
chopharmacological research and the corresponding diagnostic
expansion make use of marketing, it is easy to understand the
culture that has been created. As far as psychopharmacological
marketing is concerned, it suffices to recall that it includes a
wide variety of strategies, such as direct propaganda that reaches
patients via the media; the promotion of illnesses for the com-
mercialization of drugs; the provision of symptom lists to gen-
eral practitioners for quick diagnoses; the continual “education”
of psychiatrists; the sponsoring of conferences, symposia, and
commissions; financial support for research; influencing scientific
publications; and the financing of patients’ associations that
defend the illness model. Those still unaware of the current
situation can be enlightened by authors such as Healy (2004a),
Moncrieff (2003), Moynihan and Cassels (2005), or Valenstein
(1998). The culture created is the serotonin culture we have
described, incorporating the concept of neurochemical selves.
Having explained how the Charcot effect can still function
today, we will describe how disorders are invented through it.
The term “invention” is used here in a critical sense, to highlight
the artifactual aspect, in contrast to the supposed objective reality
in which mental disorder categories are portrayed via diagnostic
systems and psychopharmacological research. This critical sense
has both an epistemological dimension, related to the way in
which pharmaceutical matters are understood (Barry, 2005), and
an anthropological dimension, given the harmony of illusions
that can be achieved in a new diagnosis (Young, 1995). On the
314 M. Pérez-Álvarez and J. M. Garcı́a-Montes
Although the term “depression” dates from the second half of the
nineteenth century (Berrios, 1996, p. 299), it did not become the
widespread diagnosis it is today until the late twentieth century.
It is, indeed, precisely with the advent of new antidepressants
that depression increased with respect to other diagnoses (Healy,
2004b; Shorter, 2001). If we have to fix a date, this could be said
to have occurred after 1987, the year of the revised DSM-III and
the approval of Prozac.
The Charcot Effect 315
phobia has gone from being a rare disorder in 1980 to being the
third most common psychiatric diagnosis, after depression and
alcoholism, by the end of the 1990s (Moncrieff, 2003). In the
space of some 10 years, it nearly quintupled its prevalence, going
from 2.75% at the beginning of the 1980s to 13.3% by the early
1990s (Horwitz, 2002, p. 95).
Even though social phobia is clearly a questionable diagnostic
category, given the heterogeneity of its symptoms (Hofmann,
Heinrichs, & Moscovitch, 2004), and in any case its markedly
interpersonal condition (Alden & Taylor, 2004), it has the status of
a clinical entity, and indeed functions as a mental disorder (APA,
2000). From the constructivist point of view, it is interesting to
consider how this has come about.
Above all, it should be pointed out that social phobia repre-
sents a clear case of the conversion of a social and personal prob-
lem into a medical one (Moynihan et al., 2002). The initial prob-
lem would be none other than shyness (in turn a construction,
in this case more mundane than clinical). Although traditionally
shyness was not a problem, but rather a personal characteristic
and even a social style, it began to be problematized in the
1970s in response to certain social changes. These changes had
to do, above all, although not exclusively, with heterosexual roles,
whereby both feminine shyness and masculine shyness (“reserve”)
ceased to be the acceptable patterns they had been (McDaniel,
2001). The fact that social phobia affects males and females
equally (or even, unlike other phobias, affects males more; APA,
2000) is in line with these social changes that became discernible
in the mid-1970s, when women’s liberation movements began to
challenge male privilege in many fields (McDaniel, 2001).
What is important to emphasize is that these personal social
problems were shrewdly capitalized upon by the pharmaceuticals
industry, becoming among the most widespread medical prob-
lems in clinical psychiatry at the end of the 1990s. Thus, this con-
version into a clinical problem is concerned more than anything
with the history of psychopharmacology (Healy, 1997, 2004a).
In this regard, one of the leading players was the pharmaceu-
tical company GlaxoSmithKline (GSK). GSK set out to market the
SSRI-type drug paroxetine (Paxil in the United States and Seroxat
in Europe). Although Paxil is known as an antidepressant, the
The Charcot Effect 319
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