Abstract -- Advertisers have adopted the use of highly abstract visual metaphors and symbols in addressing physicians about antidepressant drugs. Campaigns built around an abstract visual aesthetics are designed to generate cognitive connections between named drug entities and the meaning of abstract visual images: these connections are called 'carry-over symbols'. In this study we critically dismantle and analyze the encoding practices used in two recent ad campaigns for antidepressants. In addition to asking what the ads mean, we ask how they mean it. This analysis is joined to a comparison of the information provided by these ads with the pharmacological and therapeutic properties of the drugs themselves. Our analysis suggests this style of drug advertising produces, as a social side-effect, a reified and medicalized account of psychiatric illness (depression). It also poses an obstacle to scientific discourse and understanding; privileges certain types of social knowledge concerning mental illness, psychiatric patients, and drug taking; and discourages professional debate regarding therapeutic approaches to treating illness. These ads reflect a positivistic conceptualization of mental illness and doctoring as mind mechanics.

Key words-drug advertising, depression, visual images

Congressional hearings spanning two decades have investigated pharmaceutical advertising practices, paying special attention to 'abuses' in advertising for psychotropic drugs. Ads for psychoactive agents are considered a matter of public concern because these drugs have effects on consciousness and behaviour, and because their ultimate consumers may be unable to make reasoned decisions in the marketplace. Advertising for psychotropic drugs is therefore treated as a moral, and political issue. Yet, regulators have acted only in moments of blatant excess by particular advertisers. For instance, in 1977 a benzodiazepine called lorazepam was marketed under the brandname Ativan.^® Slick ads promoted 'The Ativan Experience' in a full-page photograph featuring an intense halo of sunlight ringing a craggy mountain peak. Viewers found the scene connoted serenity, tranquility, rebirth, religiosity. The subtext proclaimed, "Now it ['the Ativan Experience'] can be yours" via ingestion of these chemicals. The 'Ativan Experience' seemed to refer to a secularized salvation derived from the good works of corporate medical science.

Fig. 1 Ativan ad, 1977

In glorifying the drug's effects, the ad infringed too closely on meanings of religious salvation: it seemed to extol the experience as an end in itself (a practice normally legally prohibited in our society) and thus registered an ambiguous statement about inappropriate drug taking. The ensuing uproar led to discontinuation of the ad. Still, even episodic regulation has usually been pursued to relegitimate the general state of advertising affairs as unproblematic [1].

While the Ativan^® campaign was deemed unethical because it exalted a drug experience, it does not differ structurally from most recent ads for psychoactive drugs. The Ativan^® campaign illustrated a method of layout design which encourages readers to infer connections between multiple meaning systems. A similar advertising format is used in conjunction with abstracted photographic images to market consumer-goods such as cosmetics, jeans, alcoholic drinks and cigarettes. Advertisers turn abstract pictorial representations into metaphors for a feeling or experience that may be associated with the product in question. Here, the advertising format permits the abstract image to be renamed by the given drug, and thus transformed into a symbolization of the drug's action. Though these ads are trumpeted as providing information to medical practitioners, in fact such ads reify psychiatric illness and its possible transcendence.

This form of advertising produces, as a social side-effect, a reified and medicalized account of psychiatric illness, e.g. depression. Structuring ads to yield 'carry-over symbols' entails steering readers to perform reifying interpretive procedures. Actualizing carry-over symbols' depends on readers' capacity and willingness to execute preferred interpretive moves encoded by the advertiser.¹ Embedded in the performance of these routinized interpretive pro-cedures are meanings and background assumptions which legitimate and perpetuate certain views of doctoring, drugs, and patients that are commercially advantageous to the drug industry" [2]. Competition for control of market shares has escalated reliance on a communication form that abbreviates and truncates meaning systems in order to produce signs (carry-over symbols) which stand for drug actions and patient symptoms in relation to the unspoken role of the physician.²

Why do advertisers working for pharmaceutical companies try to communicate with physicians by means of abstract and stylized graphic images of roses, masks, cracked landscapes and solar eclipses? How is scientific discourse facilitated if it is dominated by reductionist visual symbolism? What meaningful social knowledge concerning drug entities, their relation to mental health, or the relationship between physician and patient is set in motion by advertising geared to establishing 'carry-over symbols' as a means of maximizing market shares for a drug entity? Do such ads contribute to scientific understanding or thwart and mystify scientific knowledge of depression?

Within the medical profession, the issue of drug product advertising has stimulated a literature which addresses its functional, social and ethical impact on physicians' attitudes and practices. Concerns in this literature include whether these ads disseminate spurious, inaccurate, and incomplete information about drug entities [3, 4] -- a concern amplified by how these ads tacitly fulfill an educational function in the profession [4, 5]; that appeals are too frequently non-rational [6] or symbolic [7]; that images and content in these ads frequently build on, and perpetuate, social/sexual stereotypes [3, 8]. While health professionals have focused on advertising's effects on prescribing, there has also been a residual awareness that a more significant and long-term sociological impact of these ads may be on modes of diagnosis.

Studies of this literature tend to critically evaluate advertising content. Content analysis of information or images across samples of ads has uncovered a variety of patterns: e.g. a disproportionate representation of young women as mentally troubled. However, exclusive reliance on content-analytic methods identifies decontextualized patterns. Alternatively, we conduct an in-depth inspection of two recent ad campaigns for psychotropic drugs which exemplify a 'cutting edge' of current pharmaceutical advertising strategies designed to establish 'carry-over symbols' These ad campaigns for Ludiomil® (Ciba) and Desyrel® (Mead Johnson) have been conducted in conjunction with innovation-diffusion marketing strategies. We contextualize the meaningful content of these ads in terms of, and in relation to, (a) actual pharmacological and clinical aspects of these drugs, (b) formal, structural elements of the ads, and (c) wider institutional frameworks within which these messages are produced and read.

Through examination of how these ads get their meaning across, we hope to better formulate relevant questions about what gets meant. In medical journals, most ads for psychotropic drugs rely on formulaic patterns to structure their messages. To decipher these messages, readers (here, doctors) develop correspondingly formulaic patterns of reading. Across the accumulation of encodings and decodings there develops an ideological account of doctoring: it is taken as unproblematic that chemical ingestion is the preferred method of treating all mental disorders. Hemminki [9] found a positive correlation between physicians' attitudes toward using drugs as a means of dealing with the social stress of daily life and rates of prescribing psychotropic drugs. In affirming this view of illness, curing and doctoring -- a view consonant with the institutional logic of commodified science [10] -- these ads simultaneously exclude alternative accounts of therapeutic strategy [11]. One subtle social effect of this advertising style for psychotropic drugs is that it tends to discourage professional debate over therapeutic approach.