Addressing the Global Mental Health Crisis: How a Human Rights Approach Can Help End the Search for Pharmaceutical Magic Bullets

INSTITUTIONAL CORRUPTION AND HUMAN RIGHTS IN MENTAL HEALTH, Vol 27/2, 2025, pp. 179-188 PDF

Lisa Cosgrove

Abstract

Although there is a seductive neutrality to calls to end the “mental health crisis” and develop more effective psychotropics, these calls are grounded in a neoliberal sensibility. Such rhetoric deflects attention away from the lived realities of people’s lives and from the human rights violations that are often the cause of mental ill-health. Moreover, the undue influence of both industry and organized psychiatry in the mental health field create a perfect storm in which mental health research, policy, and clinical practice are driven by the search for pharmaceutical magic bullets. This search is facilitated by medicalized tropes, academic-industry relationships, an anti-regulatory climate, and guild interests, to the detriment of public health considerations. Indeed, an overly medicalized response to emotional distress violates patients’ human rights, including the rights to health and to informed consent. Using the conceptual and normative framework of institutional corruption, this paper identifies the various economies of influence that have paved the way for the fast-tracking of psychotropics with “novel” mechanisms of action. I discuss the marketing of postpartum distress (PPD) as a disorder of the hypothalamic-pituitary-adrenal axis and the “first ever” pill to treat PPD, zuranolone, as a case illustration of medicalization. I conclude by offering solutions for reform that are embedded in a human rights framework.

Introduction

“Half of World’s Population Will Experience a Mental Health Disorder”[1]

The [United States] national economic burden of TRD [treatment-resistant depression] was estimated at $43.8 billion annually.[2] 

“Globally, one in seven 10­-19-year-olds experiences a mental disorder, accounting for 15% of the global burden of disease in this age group … yet these remain largely unrecognized and untreated.”[3]

In light of these alarming statistics and headlines, it is no wonder that there are calls for increasing access to psychiatric screening and treatment and for speeding up the regulatory process so that countries can get new psychotropic medications approved more quickly. Certainly, large swaths of the population in all age cohorts are distressed, and mental ill-health is a pressing public health issue. However, calls to end the “mental health crisis” are grounded in a seductive neutrality. Such calls deflect attention away from the lived realities of people’s lives and from the human rights violations that are often the cause of mental ill-health. Unfortunately, the pharmaceutical industry has taken good advantage of the rhetoric and of the mental health disease burden estimates. Commercial entities that manufacture psychotropics have co-sponsored international events promoting the movement and have funded researchers who report on the high prevalence of mental illness and the need for greater access to treatment.[4] Matthew Roberts reports that the Gates Foundation did not offer financial support for global mental health projects because the pharmaceutical industry already provides funding.[5]

Against this backdrop, and using the conceptual and normative framework of institutional corruption, this paper discusses the various economies of influence that have paved the way for the continued search for psychotropic magic bullets. I explore the marketing of postpartum distress (PPD) as a disorder of the hypothalamic-pituitary-adrenal axis, and a resulting deficit in allopregnanolone, and the “first ever” pill to treat PPD, zuranolone, as a case example of pharmaceuticalization. I then offer solutions for reform that are embedded in a human rights framework.

The mental health crisis and medical neoliberalism

Medicalization and individualism go hand in hand, thus giving more power and political ammunition to the view that health is individual and autonomous and thus outside the purview of governmental authority and action.[6]

Neoliberal capitalism both requires and sustains the medicalization of distress. This is due in part to the fact that medicalization ignores the context and conditions in which emotional distress is embedded—such as poverty, discrimination, isolation, and oppression—and makes these human rights violations seem inevitable. Although mental ill-health is inseparable from capitalism and racism, a distinguishing feature of medical neoliberalism is the assumption that emotional distress is best conceptualized and treated as a disease. Such conceptualizations take suffering out of its “moral and political context” and lead to one-size-fits-all psychological and psychotropic interventions.[7] The medicalization of distress also encourages policy makers to use simplistic symptom-reduction models and to focus on the economic cost of mental ill-health. Metrics such as “disability-adjusted life years” (DALYs) were introduced by the World Bank and the World Health Organization in the 1990s. DALYs are based on an incidence approach that can be used (with other metrics) to calculate, per country or globally, the financial burden of having disease or disability. For over two decades, there has been ever-increasing documentation of, attention to, and rhetoric about the “burden” of mental disorders; biostatisticians identify the days, months, or years that one “loses” (economically speaking) to mental ill-health. Not surprisingly, critical psychiatrist Derek Summerfield has noted that applying the DALY metric to depression is “epistemologically lamentable.”[8]

An increasing number of researchers are documenting the ways in which neoliberal ideology and policies have contributed to the increasing rates of mental illness.[9] This scholarship provides important data that can be used to develop policies that are grounded in a human rights framework. For example, there is a substantial body of literature emphasizing the need to address economic and employment issues (e.g., through “housing first” programs) in order to prevent mental ill-health. Relatedly, researchers have found that farmer suicide in India is best predicted by cash crop production and level of debt; to significantly reduce suicide, they recommend policy-level interventions addressing the economic realities of farmers’ lives.[10] Thus, in order to stop the medicalization of despair and improve population mental health, there needs to be a concerted effort to address the drivers of medicalization. As described below, the conceptual and normative framework of institutional corruption can assist in identifying and addressing these drivers.

The normative and conceptual framework of institutional corruption

Kindergarten ethics sees the world in black and white. There are good people. There are bad people. Good comes from the former, bad from the latter … The field of “institutional corruption” was launched to help ethics grow up.[11]

The ways in which academic-industry relationships can have a biasing effect on the scientific literature and undermine evidence-based practice have been well-documented. Although all medical specialties have come under scrutiny, psychiatry could be described as being at the epicenter of this “crisis of credibility.” Much of the literature revealing the pro-industry habits of thought that are engendered by financial conflicts of interest focuses on the payments that individuals receive from industry. For example, in the United States, the Open Payments database was developed to create “a more transparent and accountable healthcare system.”[12] It provides the public with information on how much money, and for what services (e.g., consulting), prescribers have received from commercial entities. Yet as physician and bioethicist Carl Elliot notes, the focus on conflicts of interest may deflect attention away from the more pernicious problem—institutional practices:

The difficulty with conflict of interest as a way of framing the problem of industry funding is that it directs our attention to individuals … This way of framing the issues makes it sound as if these financial ties are a purely individual problem—that an individual has a problem and we need to manage it.[13]

Indeed, an acontextual focus on the amount of money individuals receive from pharmaceutical companies may give the erroneous impression of wrongdoing or quid pro quo corruption. In contrast, the framework of institutional corruption is oriented toward solutions, not blame, and avoids a focus on individuals. As legal scholar Larry Lessig puts it, “Institutional corruption is manifest when there is a systemic and strategic influence which is legal, or even currently ethical, that undermines the institution’s effectiveness by diverting it from its purpose or weakening its ability to achieve its purpose … weakening either the public’s trust in that institution or the institution’s inherent trustworthiness.”[14]

Certainly, the health care sector is exposed to quid pro quo corruption, and girls and women are particularly vulnerable. As Farzana Nawaz and Marie Chêne note, “the consequences of expensive, ill-tailored, inaccessible or unsafe health products and services hit women particularly hard.”[15] However, the conceptual and normative framework of institutional corruption broadens the scope of the problem. In so doing, it can help us better identify, understand, and mitigate the “economies of influence” that have undermined the trustworthiness of organized psychiatry—influences that reinforce medicalization and pharmaceuticalization. For example, organized psychiatry, in particular the American Psychiatric Association, has developed a financial dependence on Big Pharma. This is evidenced not only by monies given to individual psychiatrists but also by the monies given to support the organization itself, its conferences, its journals, and even its philanthropic arm, the American Psychiatric Foundation. In fact, each year, the foundation thanks its “corporate alliance” (which includes a myriad of pharmaceutical companies) for their generous support.[16]

It is not surprising that commercial entities provide financial support to organized psychiatry. Industry benefits from an overemphasis on chemical, neurobiological, and hormonal theories regarding the etiology of distress and from medicalized diagnostic conceptualizations of mental ill-health. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is often referred to as the “bible” of psychiatric disorders. Since the publication of DSM-3, when psychiatry officially adopted the medical model, industry has exerted an undue influence on organized psychiatry. This was made abundantly clear by Robert Spitzer, who chaired DSM-3; when asked by a reporter from the New Scientist what pharmaceutical companies thought of the revised manual, he said, “the pharmaceuticals were delighted!”[17] This is not to suggest that there was any wrongdoing or quid pro quo corruption on the part of the DSM panel or task force members. Rather, the former chair of the DSM was acknowledging the fact that the paradigm shift to the medical model that occurred with the publication of the manual in 1980 resulted in an industry-friendly psychiatric taxonomy. It is also important to note that, in a unique and significant way, psychiatry benefits from its dependence on commercial entities: industry creates a climate that sustains the ontological status of psychiatry and psychiatric conditions. Because of the lack of biological markers for any disorders listed in the DSM, psychiatry is unique in its need to have industry legitimize its existence as a medical subspecialty.

Guild interests

Although it is true that individual medical providers care deeply about their patients, the guild of health care professionals—including their specialty societies—has a primary responsibility to promote its members’ interests … it is a fool’s dream to expect the guild of any service industry to harness its self-interest and to act according to beneficence alone—to compete on true value when the opportunity to inflate perceived value is readily available.[18]

Congruent with Kerianne Quanstrum and Rodney Hayward’s insight, the framework of institutional corruption reveals the biasing effects of guild interests. Such interests undermine psychiatry’s ability to acknowledge the poor harm-benefit ratio of many psychotropic medications and to acknowledge that despite greater access to these agents worldwide, we have not seen improvements in population mental health. The combination of guild and industry interests also explains why organized psychiatry continues to search for pharmaceutical magic bullets and continues to export to both low- and middle-income countries an overinflated sense of efficacy about currently approved psychotropics. To paraphrase Upton Sinclair, it is difficult to get people to understand something when both their salary and allegiance to their profession depend on their not understanding it.[19]

Psychologists are also implicated in promoting their guild interests, having more confidence in psychological interventions than the empirical evidence supports, and in exporting an overly optimistic view of Western intra-individual interventions to non-Western settings. Exporting Western diagnostic models risks perpetrating epistemic injustice, can result in over- or mis-diagnosis, and is a clear example of colonial global health “aid.” For example, psychologists as well as psychiatrists were involved in developing and implementing one of the World Health Organization campaigns on depression awareness, titled “When sadness doesn’t stop: Helping Syrians talk about depression.”[20] Five years after the Syrian conflict began, the United Nations described it as the “biggest humanitarian and refugee crisis of our time.”[21] Although the campaign was well-intentioned, and acknowledging pain and sadness can certainly help heal broken communities, it nonetheless reflects a US-centric and biomedical perspective. The assumption is that the displacement and violence experienced by refugees is best understood as a psychiatric disorder and treated with talk therapy.

Fortunately, there are some signs that even the most passionate guild supporters are walking back their claims that the psychiatric conditions codified in the DSM are best understood via medicalized tropes. In 2017, Martine Hoogman, a leading international ADHD researcher who published a high-powered analysis of brain scans comparing patients with and without ADHD, stated, “patients with A.D.H.D. have altered brains; therefore A.D.H.D. is a disorder of the brain.” Eight short years later, she regretted this claim and called for a more nuanced view. As quoted in a New York Times article, Hoogman acknowledged, “‘We emphasized the differences that we found (although small), but you can also conclude that the subcortical and cortical volumes of people with A.D.H.D. and those without A.D.H.D. are almost identical.’” The article added, “[Hoogman said] it wasn’t fitting to conclude from her findings that A.D.H.D. is a brain disorder.”[22]

Yet the pull of medicalization remains strong in psychiatry in part because of its guild interests. The next section discusses the marketing of PPD as a disorder of the hypothalamic-pituitary-adrenal axis and the “first ever” pill to treat PPD, zuranolone, as a case example of the ways in which commercial influences sustain the medicalization of PPD.

The first-ever pill to treat postpartum distress: Caveat emptor

Childbirth is one of the most powerful triggers of psychiatric illness in a woman’s life.[23]

The assumptions embedded in the above quote—a contemporary version of a very old trope (women’s reproductive capacity and organs cause mental illness)—are being exported to both low- and middle-income countries. Giving birth to a child is a life-altering event that is certainly stressful, and there is a biological basis to all distress, including that which is experienced after childbirth. However, promoting the view that PPD is a homogeneous psychiatric disorder that can be explained in terms of DSM criteria and identified via the use of acontextual survey instruments (e.g., HAM-D; Edinburgh postnatal depression scale) is problematic and leads to the pharmaceuticalization of that distress. Yet women and their health care providers are being told that PPD is a psychiatric disorder with a distinct biological and hormonal cause.[24] In the publications based on the clinical trial data assessing zuranolone’s efficacy, the authors—who have financial conflicts of interest or are employees of Sage or Biogen (the pharmaceutical companies that manufacture zuranolone)—emphasize the role that low levels of allopregnanolone play in the etiology of PPD.[25] For example, the authors focus almost exclusively on the “connection between neuroactive steroid levels [i.e., allopregnanolone], network connectivity, and symptom severity in PPD.”[26] From a human rights perspective, it is important to ask, What gets erased when we make hormonal dysregulation the primary site of intervention?[27]

Additionally, health care providers and the public are being told that PPD is significantly “underdiagnosed and undertreated,” and thus there is a “silent health crisis.”[28] In late 2023, Sage received regulatory approval in the United States for zuranolone, the “first ever” pill for PPD. The cost of this new pill is almost US$1,600 for a two-week supply, and Sage will likely be able to grow its global market. In fact, a 2024 marketing report, “Postpartum Depression Drugs Market Trends,” optimistically reported:

The global postpartum depression drugs market size was estimated at USD 838.4 million in 2023 and is projected to expand at a CAGR [compound annual growth rate] of 9.63% from 2024 to 2030. The increasing prevalence of postpartum depression, growing research and development efforts, and a rise in new product launches are supporting the market expansion for postpartum depression drugs (PPD). Furthermore, an increase in awareness about the treatment options for PPD is driving market growth … The postpartum depression drugs market in Latin America is expected to grow rapidly.[29]

A critical question remains: Will Sage and Biogen be exporting an effective and safe medication for new mothers struggling after childbirth? As discussed by Vinay Prasad and David Allely, the short answer is no.[30] Unfortunately, despite regulatory approval, an assessment of the clinical trial data suggests that zuranolone barely outpaced the placebo statistically and likely offers little clinically meaningful benefit. In fact, the small difference on the outcome measure (the HAM-D) between the zuranolone and control group could be explained by either the placebo effect or regression to the mean.[31] There are also significant safety concerns. Although zuranolone is being marketed as a “neurosteroid,” the integrated summary review from the US Food and Drug Administration (FDA) notes that it is an allosteric modulator of GABA_A, which is the same pharmacodynamic action of benzodiazepines.[32] The FDA also reports that it carries the same potential for abuse and dependence as alprazolam, a benzodiazepine, and it is not known whether it is safe to breastfeed while taking zuranolone.

Returning to the framework of institutional corruption, it is helpful to ask, What are the economies of influence that are facilitating the exportation of a drug with limited efficacy data and significant safety concerns? The suggestion that PPD is the result of a chemical or hormonal imbalance—one that a magic-bullet medication can fix—is supported by organized psychiatry (with its attendant guild interests) and by researchers who are Sage employees or who have other financial conflicts of interest (e.g., holding patents on synthetic analogues of allopregnanolone).[33] Additionally, financial support of both the American Psychiatric Association and FDA by the drug industry has led critics to question whether these financial relationships have opened the door for “disease mongering.”[34] Indeed, the overemphasis on a neurobiological explanation of PPD, together with the drug narrative, “readily meld[s] scientific credibility and commercial imperatives.”[35]

Such is the case with Sage’s new drug application (NDA) for zuranolone: the FDA effectively lowered the regulatory bar by allowing Sage to compare zuranolone only to a placebo, despite the fact that Sage received Fast Track designation. This designation, according to the FDA, requires pharmaceutical companies to provide data that show some advantage over available treatments. However, as Prasad and Allely point out, selective serotonin reuptake inhibitors and psychotherapy are considered standard therapies for PPD and are recommended as interventions in many clinical practice guidelines, yet the FDA did not require any head-to-head comparisons with either antidepressants or psychotherapy.[36]

It is also instructive to more closely examine the etiological narratives that the authors of the clinical trial data are using in the published medical literature. What one finds is a story similar to that of Prozac. The marketing of Prozac reinforced the gravitas of “major depressive disorder” and the chemical-imbalance theory of depression—that is, the idea that low serotonin levels cause depression. In much the same way, zuranolone-qua-magic-bullet depends on a conceptualization of PPD as a deficit of allopregnanolone. It is noteworthy that the manufacturer did not get its NDA approved for zuranolone for major depressive disorder. The fact that the FDA did not grant regulatory approval of the drug for depression is particularly interesting because PPD could be seen as a subset of major depressive disorder; in the DSM, the condition is codified as “Major Depressive Disorder, peripartum onset.” In light of the FDA’s rejection of zuranolone for depression, heavily promoting the allopregnanolone-deficit hypothesis for PPD, and zuranolone as a novel new agent—a “neurosteroid”—is a successful marketing technique.

Additionally, medicalized conceptualizations deflect attention and resources away from addressing PPD as a public health issue. Women are encouraged to overlook the context in which their emotions are manifest and regard feelings of sadness or anxiety as by-products of hormonal changes or allopregnanolone deficiencies. Emma Tseris summarizes this point well, noting that the PPD label “renders invisible a broad array of social contexts and gendered power relations and their impacts on new mothers during the perinatal period.”[37] For example, a recent meta-analysis of studies from 56 countries found a clear relationship between wealth inequality and PPD.[38] Level of debt is also strongly associated with maternal depression, and the United States is the only one of 41 OECD nations that does not mandate paid family leave.[39] Numerous studies, including a recent systematic review, found that paid maternity leave was significantly correlated with beneficial mental health effects on both mothers and children and that there was a relationship between restrictive maternity leave policies and rates of postpartum depression.[40] The authors called on the United States to mandate a national paid leave policy of at least three months.

Unfortunately, as reported in a 2023 Lancet editorial, because both breastfeeding prevalence and breastfeeding duration are highly correlated with paid maternity leave, “some CMF [commercial milk formula] lobby groups have cautioned against improved parental leave.”[41] As described earlier, paid parental leave is associated with better maternal health and a lower incidence of PPD. Thus, CMF lobbying groups can be seen as a distal, but important, economy of influence that may contribute to the distress many women experience postpartum. The marketing of zuranolone as a “magic bullet” is an example of the promotion of pharmaceutical solutions to what are also public health issues.

A robust human rights approach as a solution for reform

The juggernaut of medicalization is a complex and powerful social and historical process that cannot be stopped with a pithy set of recommendations for cultural shifts, systemic and institutional changes, and policy reform.[42]

Although Lantz and colleagues are correct that we must be cautious about finding an easy “cure,” I agree with epidemiologist and public health activist Devra Davis, who said, “Those of us who indict past failures have a duty to develop new solutions.”[43] Toward that end, I offer the following ideas as a means to facilitate a discussion about how a human rights approach can address the drivers of medicalization and stop the resource-draining search for pharmaceutical magic bullets.

As scholars such as Amartya Sen and Martha Nussbaum describe, a human rights approach invigorates our ethical imaginations and encourages thinking about the promotion of well-being not just within individuals but within societies. Critical thinking about the mental health crisis must start with the recognition that the field of global mental health has been subsumed by the medical model. Thus, what is needed is nothing short of a “moral renaissance,” a paradigm shift, and the development of new narratives.[44] Such a suggestion may seem overly ambitious and perhaps even impossible. However, the policy reset recently suggested for suicide prevention, where the focus shifts “from health departments to all parts of government,” provides both hope and a road map.[45] This policy reset is grounded in a population health approach and has a clear human rights impulse. Specifically, the focus is on addressing and ameliorating the upstream and often sociopolitical and economic precipitants of suicide. cause many social determinants can best be addressed by creating economic safety nets (e.g., a universal living wage), this public health approach to suicide prevention involves a “whole of government and whole of society” approach where there is a “strong commitment from a range of government sectors, many of which fall outside of health.”[46]

However, making a similar commitment for tackling the mental health crisis will come to fruition only if researchers and clinicians develop and promote less medicalized narratives about mental health. As neurologist and Alzheimer’s expert Peter Whitehouse astutely notes, “He/she/they that control language also control resources and manipulate the sources of hope.”[47] Thus, in order to facilitate a commitment from a wide range of government sectors and engender a more robust human rights approach in the field of global mental health, there will need to be a marked shift in the language we use about mental well-being and the narratives we use to understand the “mental health crisis.” Nick Chater and George Lowenstein, two leading behavioral social scientists, eloquently argue for the need to shift from individual (i-level) to society (s-level) theoretical frameworks:

An influential line of thinking in behavioral science, to which the two authors have long subscribed, is that many of society’s most pressing problems can be addressed cheaply and effectively at the level of the individual, without modifying the system in which the individual operates. We now believe this was a mistake, along with, we suspect, many colleagues in both the academic and policy communities … behavioral scientists [have framed] policy problems in individual, not systemic, terms: To adopt what we call the “i-frame,” rather than the “s-frame.” The difference may be more consequential than i-frame advocates have realized, by deflecting attention and support away from s-frame policies.[48]

A human rights approach, as articulated by psychiatrist Dainius Pūras, former United Nations Special Rapporteur on the right to health, focuses on the “global burden of obstacles” rather than the global burden of mental disorders.[49] As such, a human rights approach is congruent with and extends this s-level focus. Fortunately, there are increasing efforts to transform the global mental health movement from a top-down, individualized, and treatment-oriented approach toward a rights-based conception that accounts for the political, and economic conditions that produce distress and disability.[50] These efforts will be enhanced to the degree that we genuinely center the insights and ideas of individuals with lived experience in mental health research, policies, and practices.

It is clear that addressing the sociopolitical determinants of mental health and mitigating industry and guild interests will require more nuanced narratives about mental ill-health—ones that focus on how to prevent it and help people flourish. Publishing critiques of medicalization in the scientific literature is helpful, but more innovative efforts are also needed. For instance, human rights scholars and activists can assist the media¹ in learning how to frame the story of the “mental health crisis” with more nuance, complexity, and appreciation for the upstream causes of distress. Indeed, a human rights framework can facilitate greater public scrutiny about the iatrogenic consequences of taking emotional suffering out of its moral, ethical, and political context.[51]

Lisa Cosgrove is a professor in the Department of Counseling and School Psychology, University of Massachusetts, Boston, United States.

Please address correspondence to the author. Email: lisa.cosgrove@umb.edu.

Competing interests: None declared.

Copyright © 2025 Cosgrove. This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

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[2] M. Zhdanava, D. Pilon, I. Ghelerter, et al., “The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States,” Journal of Clinical Psychiatry 82/2 (2021).

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[4] F. Herrawi, J. Logan, C. P. Cheng, and L. Cosgrove, “Global Health, Human Rights, and Neoliberalism: The Need for Structural Frameworks When Addressing Mental Health Disparities,” Journal of Theoretical and Philosophical Psychology 42/1 (2022); L. Cosgrove and A. F. Shaughnessy, “Mental Health as a Basic Human Right and the Interference of Commercialized Science,” Health and Human Rights 22/1 (2020).

[5] M. T. Roberts, “Globalization and Neoliberalism: Structural Determinants of Global Mental Health?,” Humanity and Society 45/4 (2020).

[6] P. M. Lantz, D. S. Goldberg, and S. E. Gollust, “The Perils of Medicalization for Population Health and Health Equity,” Milbank Quarterly 101/S1 (2023), p. 77.

[7] A. Kleinman, What Really Matters: Living a Moral Life Amidst Uncertainty and Danger (Oxford University Press, 2006).

[8] D. Summerfield, “Western Depression Is Not a Universal Condition,” British Journal of Psychiatry 211/1 (2017), p. 52.

[9] C. Mills, “‘Dead People Don’t Claim’: A Psychopolitical Autopsy of UK Austerity Suicides,” Critical Social Policy 38/2 (2018); A. Zeira, “Mental Health Challenges Related to Neoliberal Capitalism in the United States,” Community Mental Health Journal 58/2 (2022).

[10] J. Kennedy and L. King, “The Political Economy of Farmers’ Suicides in India: Indebted Cash-Crop Farmers with Marginal Landholdings Explain State-Level Variation in Suicide Rates,” Global Health 10/1 (2014).

[11] L. Lessig, “‘Institutional Corruption’ Defined,” Journal of Law, Medicine, and Ethics 41/3 (2013), p. 553.

[12] Centers for Medicare and Medicaid Services, “What Is the Open Payments Program?,” https://www.cms.gov/priorities/key-initiatives/open-payments.

[13] C. Elliot, “Industry-Funded Bioethics and the Limits of Disclosure,” in D. G. Arnold (ed), Ethics and Business of Biomedicine (Cambridge University Press, 2009), p. 161.

[14] Lessig (see note 11), p. 553.

[15] F. Nawaz and M. Chêne, “Gender, Corruption and Health,” U4 Anti-Corruption Resource Centre (August 10, 2009), https://www.u4.no/publications/gender-corruption-and-health.

[16] American Psychiatric Association, “Corporate Alliance,” https://www.apaf.org/ways-to-give/corporate-alliance-as-a-way-to-get-involved-donate/.

[17] J. Ronson, “Bipolar Kids: Victims of the ‘Madness Industry’?,” New Scientist 210/2815 (2011).

[18] K. H. Quanstrum and R. A. Hayward, “Lessons from the Mammography Wars,” New England Journal of Medicine 363/11 (2010), p. 1078 (emphasis added).

[19] U. Sinclair, I, Candidate for Governor: And How I Got Licked (University of California Press, 1994).

[20] World Health Organization, “When Sadness Doesn’t Stop: Helping Syrians with Depression” (June 15, 2017), https://www.who.int/news/item/15-06-2017-when-sadness-doesn-t-stop-helping-syrians-with-depression.

[21] United Nations, “Syria Conflict at 5 Years: The Biggest Refugee and Displacement Crisis of Our Time Demands a Huge Surge in Solidarity,” United Nations High Commissioner for Refugees (March 15, 2016), https://www.unhcr.org/us/news/news-releases/syria-conflict-5-years-biggest-refugee-and-displacement-crisis-our-time-demands.

[22] P. Tough, “Have We Been Thinking About A.D.H.D. All Wrong?,” New York Times (April 13, 2025), https://www.nytimes.com/2025/04/13/magazine/adhd-medication-treatment-research.html.

[23] C. T. Beck, “Postpartum Depression Screening Scale: Its Availability for Use,” Journal of the American Psychiatric Nurses Association 30/5 (2024), p. 896.

[24] L. M. Osborne, J. F. Betz, G. Yenokyan, et al., “The Role of Allopregnanolone in Pregnancy in Predicting Postpartum Anxiety Symptoms,” Frontiers in Psychology 10 (2019); S. Meltzer-Brody and S. J. Kanes, “Allopregnanolone in Postpartum Depression: Role in Pathophysiology and Treatment,” Neurobiology of Stress 12 (2020).

[25] K. M. Deligiannidis, S. Meltzer-Brody, H. Gunduz-Bruce, et al., “Effect of Zuranalone vs Placebo in Postpartum Depression: A Randomized Control Trial,” JAMA Psychiatry 78/9 (2021).

[26] K. M. Deligiannidis, S. Meltzer-Brody, B. Maximos, et al., “Zuranalone for the Treatment of Postpartum Depression,” American Journal of Psychiatry 180/9 (2023), p. 668.

[27] E. Tseris, “The Psychiatric Surveillance of Pregnancy and Early Parenting,” in M. Harbusch (ed), Troubled Persons Industries: The Expansion of Psychiatric Categories Beyond Psychiatry (Palgrave Macmillan, 2022); personal communication with Ashley Murray (May 6, 2025).

[28] Beck (see note 23), p. 896; H. Robidoux, A. Williams, C. Cormack, and E. Johnson, “Maternal Postpartum Depression Screening and Referral in a Latinx Immigrant Population: A Quality Improvement Study,” Journal of Immigrant and Minority Health 25/5 (2023).

[29] Grand View Research, Postpartum Depression Drugs Market Size, Share and Trends Analysis Report by Type (Postpartum Blues, Anxiety, PTSD), by Treatment (Pharmacotherapy, Hormonal Therapy), by Route of Administration, by Distribution Channel, by Region, and Segment Forecasts, 2024–2030 (2024), https://www.grandviewresearch.com/industry-analysis/postpartum-depression-drugs-market-report (emphasis added).

[30] V. Prasad and D. Allely, “Concerns That May Limit the Utility of Zuranalone,” JAMA 331/2 (2024).

[31] Ibid.; A. E. Yamin and L. Cosgrove, “Extending the Concept of ‘Obstetric Violence’ to Post-Partum Experiences: Cautions Regarding the ‘First Ever’ Pill for Post-Partum Depression,” Sexual and Reproductive Health Matters 32/1 (2024).

[32] Center for Drug Evaluation and Research, Integrated Review (May 25, 2022), https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/217369Orig2s000IntegratedR.pdf.

[33] G. Pinna, F. B. Almeida, and J. M. Davis, “Allopregnanolone in Postpartum Depression,” Frontiers in Global Women’s Health 3 (2022); Osborne et al. (see note 24).

[34] L. Tiefer, “Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance,” PLOS Medicine 3/4 (2006).

[35] A. Matheson, “Corporate Science and the Husbandry of Scientific and Medical Knowledge by the Pharmaceutical Industry,” BioSocieties 3 (2008), p. 359.

[36] Prasad and Allely (see note 30).

[37] Tseris (see note 27), p. 174.

[38] J. Hahn-Holbrook, T. Cornwell-Hinrichs, and I. Anaya, “Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-Analysis, and Meta-Regression of 291 Studies from 56 Countries,” Frontiers in Psychiatry 8 (2018).

[39] G. Livingston and D. Thomas, “Among 41 Countries, Only U.S. Lacks Paid Parental Leave,” Pew Research Center (December 16, 2019), https://www.pewresearch.org/short-reads/2019/12/16/u-s-lacks-mandated-paid-parental-leave/.

[40] L. Hidalgo-Padilla, M. Toyama, J. H. Zafra-Tanaka, et al., “Association Between Maternity Leave Policies and Postpartum Depression: A Systematic Review,” Archives of Women’s Mental Health 26/5 (2023), p. 571; M. S. Van Niel, R. Bhatia, N. S. Riano, et al., “The Impact of Paid Maternity Leave on the Mental and Physical Health of Mothers and Children: A Review of the Literature and Policy Implications,” Harvard Review of Psychiatry 28/2 (2020).

[41] Lancet, “Unveiling the Predatory Tactics of the Formula Milk Industry,” Lancet 401/10375 (2023), p. 409.

[42] Lantz et al. (see note 6), p. 75.

[43] D. Davis, The Secret History of the War on Cancer (Basic Books, 2007), p. 197.

[44] T. Beck, “Psychology, Personhood, and the Crisis of Neoliberalism: Jeff Sugarman on Theoretical and Critical Psychology,” Mad in America (2025), https://www.madinamerica.com/2025/03/psychology-personhood-and-the-crisis-of-neoliberalism-jeff-sugarman-on-theoretical-and-critical-psychology/.

[45] M. Sinyor, M. Silverman, J. Pirkis, and K. Hawton, “The Effect of Economic Downturn, Financial Hardship, Unemployment, and Relevant Government Responses on Suicide,” Lancet Public Health 9/10 (2024), p. e802.

[46] Ibid., p. e802.

[47] A. Aftab, “Social Constructionalism Meets Aging and Dementia,” Psychiatry Times (January 27, 2020), https://www.psychiatrictimes.com/view/social-constructionism-meets-aging-and-dementia.

[48] N. Chater and G. Loewenstein, “The I-Frame and the S-Frame: How Focusing on Individual-Level Solutions Has Led Behavioral Public Policy Astray,” Behavioral and Brain Sciences 46 (2023), p. 1 (emphasis added).

[49] Human Rights Council, Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, UN Doc. A/HRC/35/21 (2017), p. 5.

[50] B. Davar, “From Mental Illness to Psychosocial Disability: Choices of Identity for Women Users/Survivors of Psychiatry in Self and Identity Constructions,” Indian Journal of Gender Studies 15/2 (2008); L. Cosgrove, Z. Morrill, J. M. Karter, et al., “The Cultural Politics of Mental Illness: Toward a Rights‐Based Approach to Global Mental Health,” Community Mental Health Journal 57/1 (2021).

[51] Kleinman (see note 7); Human Rights Council (see note 49).