In May 1993, a mental disorder that had been in DSM-III was repackaged, renamed, and given new life in DSM-IV. It was called Premenstrual Dysphoric Disorder and was listed in the DSM as a mental disorder. Up to 8 percent of women were said to suffer from the condition. And the condition was apparently nasty. Its main symptoms occurred two weeks before menstruation and included feelings of fatigue, anxiety, emotional instability, disinterest in daily activities, and difficulty in concentrating. In short, Premenstrual Dysphoric Disorder was first presented as if it were an exaggerated form of PMT—premenstrual tension.
By the early 2000s, the number of women in the United States being diagnosed with PMDD was rising exponentially. And there are some obvious reasons for this. The first was that in 1998 the FDA in the United States recognized the condition as an official mental disorder. This freed up doctors to start diagnosing PMDD when previously they had no disorder category to which they could match premenstrual experiences. Second, the pharmaceutical industry now had the green light to market the disorder and its cure. Eli Lilly was the first to step up to the plate by spending $30 million on advertising its chemical cure.
The following advert by the company is illustrative of the type of commercial with which it flooded the airwaves once FDA approval was granted. It shows a woman who has lost her keys growing increasingly frustrated. The voiceover breaks through:
Think it's PMS? It could be PMDD—premenstrual dysphoric disorder. You know, those intense moods and physical symptoms the week before your period. Sound familiar? Call to get free information about PMDD and a treatment your doctor has to relieve its symptoms. Why put up with this another month?
Alongside such direct-to-consumer pharmaceutical adverting, Eli Lilly launched a marketing campaign targeting psychiatrists, gynecologists, and mental health providers, who were soon all receiving promotional materials: flyers, free samples, invitations to Lilly talks, and unsolicited visits from pharma reps. As the word spread in the medical community, diagnoses of PMDD quickly soared, and so did the prescriptions.
In the mid-2000s when I met a psychotherapist called John, I was therefore unsurprised to hear he had just recently treated a patient diagnosed with the condition. The patient, Sarah, was an attractive 25-year-old with deep auburn hair and strong, dark brown eyes. She entered his consulting room, lowered herself gently into a chair, and began telling him her story.
"I really am not myself at the moment. I feel so anxious and confused all the time. I just feel, well, different. It started about six months ago. I began to get these god-awful cramps before my period. It was like my guts were digesting acid. I also got these piercing headaches and I'd feel emotionally all over the place. I went to my local doctor and he sent me to a gynecologist. The gynecologist said he couldn't find anything physically wrong with me and said I was probably suffering from a psychological disorder I'd never heard of before—Premenstrual Dysphoric Disorder—and he said he could help."
Sarah then said she had been prescribed a new drug called Sarafem. John asked her what she knew about the drug. "Not much, really." She shrugged nonchalantly. "Apparently it helps with mood swings and other stuff. I take it every day, and I think it helps with the headaches. I don't know much more than that."
Let me fill the gaps in Sarah's knowledge.
The pharmaceutical giant Eli Lilly makes Sarafem. Its name is a rework of "seraphim," a Hebrew word meaning "angel," a word with obvious female overtones. Its packaging also conjures up stereotypical female associations. The pill is encased in a pretty pink-and-lavender shell, and is heralded by Lilly as a wonder cure for this distinctly female premenstrual disorder. So far so good.
Now here comes the interesting bit. What Eli Lilly initially concealed from the millions of women taking the pill is that the pill is actually Prozac. Chemically, Sarafem and Prozac are exactly the same. The only difference between them is that their names and packaging are different. Sarah, like thousands of other women up and down the country, was taking Prozac and didn't know it.
