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Seeing Red: Selling Generalized Anxiety Disorder

When a British drug-maker plagiarized a Polish film-maker.

"Be sad," a voice-over implores. "Think of something awful."

It's a strange, haunting scene in the 1994 hit film Red—part of Polish film-director Krzystof Kieslowski's famous Tricolor series. An ethereal Irene Jacob plays a model who's taking part in an ad campaign for chewing gum, of all things. As she blows a bubble for the camera, the photographer in the film, suddenly earnest, asks her to remove the gum and look sad . . . No, sadder than that. He says, Think of something awful.

Even allowing for artistic license (which Kieslowski famously pushed to its limits), it's never clear in the film why a photographer would ask his model to remove a product they're both being paid to promote, or, indeed, why the product itself never appears in the final ad. The implied link between gum and sadness is no less baffling. True, Red is set in the chic Geneva of the early 1990s and—as Kieslowski clearly intended in his Tricolor series—proudly revels the shared tradition of its Swiss-French-Polish production. But though Jacob does her best to channel a model trying to look completely miserable, even I—a fan of Kieslowski's work—find it absurd when the photographer shouts excitedly, "That's it!"

Cut to 2001. I'm researching a book on the new mental disorders—all 112 of them—that have entered the third edition of the Diagnostic and Statistical Manual of Mental Disorders, arguably the world's diagnostic bible of mental health. "Anxiety neurosis" has proliferated into seven new "anxiety disorders," including "Generalized Anxiety Disorder"—which, strange to say, is now running in television ads of its own, this time in the U.S., and just a month after 9/11. The ad campaign features the voice of an anxious woman saying, "I'm always thinking something terrible is going to happen." Subtle it was not—either as timing or as plagiarism.

Another ad by GSK earlier that year featured a model clearly channeling Irene Jacob and ripping off the entire premise of Red. A simple coincidence? That seems unlikely, given the degree of overlap. Decked out in red, with matching crimson lipstick and sweater, the model in GSK's ad is clearly trying to "think of something awful" and doing a reasonable job of it.

With its blatant echo, "I'm always thinking something terrible is going to happen," GSK surely hoped that its own promotional campaign in October 2001 would give viewers an answer to the profound shock of 9/11. You could call that good timing, or a shade opportunistic, or even a blatant example of cashing in on national shock and tragedy. But even aside from that issue, there's something really disturbing about a drug maker plagiarizing an independent film to sell its product and, with it more generally, the very concept of "generalized anxiety disorder."

Over the next year, GSK spent more than $92 million promoting Generalized and Social Anxiety Disorder as a new way of describing shock, malaise, and social embarrassment. The bar for each diagnosis was set so low that the official symptoms included fear of eating alone in a restaurant and concern about hand-trembling while writing a check. The psychiatrists who coined the terms even told me, quite matter-of-factly, that GAD was simply everything about anxiety that didn't fit the other six anxiety disorders they had created. As Robert Spitzer, chair of the psychiatric task force in question, told me in an interview: "If you had panic, then there had to be something that was left over. So that became Generalized Anxiety Disorder."

In effect, the psychiatrists had a name for something they couldn't quite define, restrict, or identify—a label they first conjured in committee meetings and in a diagnostic manual so that other psychiatrists could apply it to a group of people we sometimes call "the worried well." Like the pharmaceutical ads, the scenario could have come to us straight from a Kieslowski film.

GlaxoSmithKline's debt to Kieslowski may make us wonder whether the latest round of mental disorders has reached us more or less directly from film and the wider culture. That idea is not as far-fetched as one might think. In asking whether those with "Internet Addiction Disorder" should soon swell the ranks of the mentally ill, the American Psychiatric Association firmly insists that it is responding to cultural pressures and symptoms. It sees the amount of texting and Internet surfing going on and insists that's a problem for which some of us need a fresh round of medicationin some cases, incredibly, hospitalization.

The American Psychiatric Association and the PR consultants serving the drug companies don't need to stop watching Kieslowski and other art-house films. They could learn a lot from them, including the difference between real and manufactured suffering. But if the medium really is the message, as Marshall McLuhan famously observed, then drug companies should be careful about borrowing too much from the movies. When it comes to naming and promoting new mental disorders, some of us would feel less generalized anxiety if the real guide were science, not art.  Follow me on Twitter @christophlane